Buprenorphine for pain
Buprenorphine is a strong opioid painkiller. It's used to treat severe pain, for example during or after an operation or a serious injury, or pain from cancer.
It's also used for other types of pain you've had for a long time, when weaker painkillers have stopped working.
It can also be used to treat drug addiction, but this is usually by a specialist.
Buprenorphine for pain is available only on prescription. It comes as:
- patches to put on your skin
- tablets that dissolve in your mouth (sublingual)
- injections (usually only given in hospital)
- Buprenorphine works by blocking pain signals from travelling along the nerves to the brain.
- The most common side effects of buprenorphine are constipation, feeling sick and sleepy.
- It is possible to become addicted to buprenorphine, but this is rare if you are taking it to relieve pain and your doctor is reviewing your treatment often.
- It's best not to drink alcohol when you first start taking (or using) buprenorphine. You're more likely to get side effects such as feeling sleepy or drowsy.
- Tell a doctor or nurse about your buprenorphine patch if you're having any treatment or tests. Also, remind your pharmacist about your patch when you collect prescriptions or buy other medicines.
Who can and cannot have buprenorphine
Buprenorphine can be used by most adults and sometimes children if a specialist doctor recommends it.
Buprenorphine patches are usually only recommended if you've been taking other strong opioid painkillers.
Your doctor will work out how much buprenorphine to give you, depending on what dose of other opioids you have had.
Buprenorphine is not suitable for some people. Tell your doctor before starting it if you:
- have ever had an allergic reaction to buprenorphine or any other medicines
- have breathing difficulties such as asthma or a lung condition
- are a heavy drinker, or addicted to alcohol or other drugs
- have a head injury or condition that causes fits or seizures
- have irregular heartbeats (arrhythmia)
- have kidney or liver problems
- have low blood pressure
- have myasthenia gravis (a condition where muscles become weak)
- are trying to get pregnant, are pregnant or breastfeeding
How and when to use it
It's important to follow your doctor's instructions about how to use buprenorphine.
Doses vary from person to person. Your dose will depend on:
- how bad your pain is
- how you've responded to other painkillers
- if you get any side effects from buprenorphine
Buprenorphine tablets and injections are fast-acting. They're used for pain that is expected to last for a short time.
Buprenorphine patches are slow-release. This means buprenorphine is gradually released through the skin into your body.
Strength of buprenorphine
Buprenorphine comes in different strengths, depending on the type:
- patches – these release 5 micrograms, 10 micrograms, 15 micrograms or 20 micrograms every hour for 7 days, or 35 micrograms, 52.5 micrograms or 70 micrograms every hour for 3 or 4 days
- tablets – 200 micrograms or 400 micrograms
How often to take or use buprenorphine
How often you take or use buprenorphine depends on the type that you've been prescribed:
- patches – apply a new patch every 3, 4 or 7 days, depending on the strength and the brand you've been prescribed
- tablets – taken when you need them for pain relief – each dose will usually last 6 to 8 hours. Talk to your doctor if this is not controlling your pain
Some patches keep working after they have been removed, as they "store" buprenorphine under the skin. Buprenorphine patches take longer to start working, but last longer. They're used when pain lasts for a long time.
Sometimes your doctor may prescribe a buprenorphine patch, with another fast-acting painkiller. This is to manage sudden flare-ups of pain that "break through" the relief the patches give.
Do not apply more than 1 patch at a time. Using more than 1 patch could cause a fatal overdose.
Will my dose go up or down?
Before taking or using buprenorphine, you will usually start on a low dose of another type of opioid, such as morphine. This is increased slowly until your pain is well controlled.
Once your pain is under control, your doctor may swap you to buprenorphine patches. This will avoid you having to take tablets each day.
If your doctor agrees that you can stop taking buprenorphine, they will reduce the strength of your patch gradually. This is especially important if you've been taking it for a long time. It will reduce the risk of withdrawal symptoms.
Your doctor may switch you to morphine tablets or liquid or another similar painkiller so they can reduce the dose of buprenorphine even more slowly.
How to apply a buprenorphine patch
- Read the instructions that come with your patch carefully.
- Remove the patch from the packet – do not use scissors to open it as you may cut the patch. Do not cut patches unless your doctor has told you to.
- Keep the empty packet – you will need to put your used patch in this to keep it safe. You will then need to return both to your pharmacist who will destroy them safely.
- Peel off the plastic from the back of the patch. Do not touch the sticky side of the patch.
- Apply the patch to clean, dry, flat, undamaged skin. Do not touch the sticky side of the patch. Choose somewhere you can reach easily such as the top of your chest or top of your arm. Try to avoid very hairy areas, or clip the hairs first before applying the patch. If you find shaving easier, shave the area a few days before you apply the patch to make sure shaving does not irritate your skin.
- Do not cover the patch with anything including a dressing or tape. Talk to your doctor or pharmacist if you find your patch does not stick very well.
- Wash your hands after touching the patch.
Do not expose your patch to strong heat or sunlight while wearing it, as this can increase the amount of buprenorphine that gets absorbed into your skin and can increase the risk of side effects or overdose. This includes long hot baths, saunas, electric blankets, hot water bottles, heat pads and sunbathing.
You can have showers and go swimming. Check the patch is still on properly afterwards and dry the area around the patch carefully.
What to do if your patch falls off
Check your patch every day to make sure it stays stuck to you, especially around the edges.
If your patch is missing, make sure it has not stuck to another person by mistake. It's important to find it and put it back in the packet until you can return it to your pharmacist.
If a patch falls off before you need to change it, put another patch on a different part of your body and put the old patch back in the packet it came in.
Continue to change this patch on your usual day and time. For example, if you normally change your patch on a Monday and it comes off on Wednesday, replace it on Wednesday and change it as usual on Monday.
Call your local emergency service (after you have removed the patch) if:
- a buprenorphine patch sticks to someone it has not been prescribed for
Changing your patch
When you change your patch, try to do it at the same time of day. Think of ways to help you remember when to change it. You could:
- write the details on your calendar
- write the time and date on the surface of the patch itself (using a soft-tip permanent marker pen)
- use a phone app or smart speaker to record the time
Storing buprenorphine safely
Keep all types of buprenorphine in a safe place and out of reach of children or vulnerable adults.
Used patches still contain buprenorphine that can be dangerous to someone else. It's important to stick the sticky sides back together after you have taken them off and keep them safe until you can take them back to your pharmacist.
What if I forget to take or apply it?
This will vary depending on which type of buprenorphine you're using. Tablets are only taken when you need them and so you are unlikely to forget.
If you forget to apply a patch, check the information on the patient information leaflet inside the packaging, or ask your pharmacist or doctor for advice on what to do.
Never take 2 doses at the same time to make up for a forgotten one.
Always remove the old patch before applying a new one. Never apply more than 1 patch at a time.
If you often forget to change patches, it may help to set an alarm to remind you.
What if I take or use too much?
Too much buprenorphine can be dangerous. However, the amount that can lead to an overdose varies from person to person.
If you've taken too much you may feel very sleepy, sick or dizzy. You may also find it difficult to breathe. In serious cases you can become unconscious and may need emergency treatment in hospital.
Make sure your patch does not get stuck to someone else's skin, especially a child, by accident – for example if it falls off in bed or if the patch falls on the floor.
Call your local emergency service if:
- you've taken too much buprenorphine and find it difficult to breathe
- you or someone else swallows a buprenorphine patch
Taking buprenorphine with other painkillers
Like all medicines, buprenorphine can cause side effects in some people, but many people have no side effects or only minor ones.
You are more likely to get side effects with higher doses of buprenorphine.
Common side effects
Common side effects happen in more than 1 in 100 people. Talk to your doctor or pharmacist if the side effects bother you or do not go away:
- feeling or being sick (nausea or vomiting)
- feeling sleepy or tired
- feeling dizzy or a sensation of spinning (vertigo)
- stomach pain
- itching or skin rashes
Serious side effects
Serious side effects happen in less than 1 in 100 people.
Call your doctor (if you are wearing a patch, remove your patch) if:
- your muscles feel stiff for no obvious reason
- you feel dizzy, tired and have low energy – this could be a sign of low blood pressure
Call your local emergency service if:
- you have difficulty breathing or short shallow breathing
- you have had a fit or seizure
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to buprenorphine.
Call your local emergency service if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of buprenorphine. For a full list see the leaflet inside your medicines packet.
How to cope with side effects
What to do about:
- constipation – try to eat more high-fibre foods such as fresh fruit and vegetables, and cereals. Try to drink several glasses of water or other non-alcoholic liquid each day. If you can, it may also help to do some gentle exercise. Speak to your doctor about medicine to help prevent or treat constipation caused by buprenorphine if your symptoms do not go away.
- feeling or being sick – this side effect should normally wear off after a few days. Drink plenty of fluids, such as water or squash, to avoid dehydration. If you're being sick, take small, regular sips of water. Talk to your doctor about taking anti-sickness medicine if it lasts longer than a few days.
- stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you are in a lot of pain, speak to your pharmacist or doctor.
- feeling sleepy or tired – these side effects should wear off within a week or two as your body gets used to buprenorphine. Talk to your doctor if they carry on for longer.
- feeling dizzy or a sensation of spinning (vertigo) – stop what you're doing and sit or lie down until you feel better. If the feeling does not go away, do not take any more medicine and speak to a pharmacist or your doctor. Do not drive, ride a bike or use tools or machinery.
- confusion – talk to your doctor if you feel confused, your dose may need to be changed.
- headaches – make sure you rest and drink plenty of fluids. Do not drink alcohol as this can make headaches worse. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of using buprenorphine. Talk to your doctor if they last longer than a week or are severe.
- itching or skin rash – it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If symptoms do not go away or get worse talk to your doctor as you may need to try a different painkiller.
Pregnancy and breastfeeding
Buprenorphine and pregnancy
Buprenorphine is generally not recommended during pregnancy.
There is very little information on taking buprenorphine in pregnancy. If you take buprenorphine at the end of pregnancy there's a risk that your baby may get withdrawal symptoms or be born addicted to buprenorphine.
However, it's important to treat pain in pregnancy. For some pregnant women with severe pain, buprenorphine might be the best option. Your doctor is the best person to help you decide what's right for you and your baby.
For more information about how buprenorphine can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.
Buprenorphine and breastfeeding
Buprenorphine is not usually recommended if you're breastfeeding.
Small amounts of buprenorphine pass into breast milk and can cause breathing problems for your baby. Speak to your doctor, as they may want to recommend a different painkiller.
Cautions with other medicines
Some medicines and buprenorphine interfere with each other and increase the chance that you will have side effects.
Tell your doctor if you are taking any medicines:
- to help you sleep
- for mental health problems including depression, or to reduce stress or anxiety
- for high blood pressure
- to help stop you feeling or being sick
- to treat symptoms of an allergy
- for any infection (including HIV)
- to control fits or seizures
Mixing buprenorphine with herbal remedies and supplements
It's not possible to say that herbal medicines or remedies are safe to take with buprenorphine.
They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.