How and when to use buprenorphine - Brand names: Butec, Buvidal, Espranor, Suboxone, Subutex

Follow your doctor's instructions about how to use this medicine. This is particularly important because buprenorphine can be addictive.

For end of life (palliative) care, your doctor will monitor how well buprenorphine is working to control your pain. Speak to them if you're worried about addiction.

Buprenorphine tablets and injections work quickly. 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. They take longer to start working, but last longer. They're used when pain lasts for a long time.

Some patches keep working after they've been removed, as they store buprenorphine under the skin.

Dosage and strength

Buprenorphine for pain comes in different strengths, depending on the type:

• patches 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 contain 200 micrograms or 400 micrograms

Doses vary from person to person. Your dose will depend on:

• what you're taking it for
• how bad your pain is
• how you've responded to other painkillers
• whether you get any side effects from buprenorphine
• whether you're taking other medicines

Changes to your dose

Before taking or using buprenorphine, you'll 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'll 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 even more slowly.

How to take or use it

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. Always remove the old one first.

Sometimes your doctor may prescribe a buprenorphine patch with another painkiller. This is to manage sudden flare-ups of pain that break through the relief the patches give.

How to apply a buprenorphine patch

1. Read the instructions that come with your patch carefully.
2. Remove the patch from the packet. Do not cut patches unless your doctor has told you to.
3. Peel off the plastic from the back of the patch. Do not touch the sticky side of the patch.
4. 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 trim 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.
5. Press the patch against your skin for at least 30 seconds. Make sure it sticks well, especially the edges.
6. If your doctor tells you to use more than 1 patch, follow the instructions that come with the patches. Do not let the patches overlap on your skin.
7. Do not cover the patch or patches with anything including a dressing or tape. Talk to your doctor or pharmacist if you find your patch does not stick very well.
8. Wash your hands after touching a 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 or baths and go swimming. Check the patch is still on properly afterwards and dry the area around the patch carefully.

Changing your patch

When you replace a patch, fold the used patch in half with the sticky side inwards and put it in the empty packet from your new patch. You'll then need to return both the packet and the used patch to your pharmacist who will destroy them safely.

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

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, especially a child, by accident – for example if it falls off in bed or if the patch falls on the floor.

It's important to find it then fold the patch in half with the sticky side inwards. Keep it safe 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.

For patches that you normally change after 7 days, change the replacement 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.

For patches that you normally change after 3 or 4 days, make a note of the day and time when you put on the replacement patch. Then change the patch again after a further 3 or 4 days as usual.

Tablets

Check the information leaflet for how to take buprenorphine tablets. Depending on which type of tablets you have, you'll either put them under your tongue or on your tongue. Let the tablets dissolve in your mouth. Do not swallow them.

The information leaflet will also tell you whether you can take the tablets with food.

Take tablets 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.

How long to use or take it for

Depending on why you're using buprenorphine, you may only need to use it for a short time.

For example, if you're in pain after an injury or operation, you may only need to use buprenorphine for a few days or weeks.

You may need to use it for longer if you have a long-term condition.

Storing buprenorphine safely

Keep all types of buprenorphine in a safe place and out of reach of children or vulnerable adults.

Used patches can still contain buprenorphine that can be dangerous. It's important to fold a patch in half with the sticky side inwards after you've taken it off. Keep it safe until you can take it back to your pharmacist.

If you forget to use it

If you miss a dose, what to do will vary depending on which type of buprenorphine you're using.

Tablets are usually only taken when you need them so you're unlikely to forget. However, if you're unsure what to do, ask your pharmacist or doctor for advice.

Never take 2 doses at the same time. Never have an extra dose to make up for a forgotten one.

If you forget to apply a patch, check the information on the leaflet inside the packaging, or ask your pharmacist or doctor for advice on what to do.

Always remove the old patch before applying a new one. Never apply more than 1 patch at a time, unless your doctor tells you to.

If you often forget to change patches, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

If you take or use too much

It's important not to take or use more than your prescribed dose, even if you think it's not enough to relieve your pain. Speak to your doctor first if you think you need a different dose.

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.

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the buprenorphine packet, or the leaflet inside it, plus any remaining medicine with you.

Stopping buprenorphine

If you need to take or use buprenorphine for a long time your body can become used to it.

This is not usually a problem. However, you could get withdrawal symptoms if you stop using it suddenly.

If you want to stop using buprenorphine, talk to your doctor first. Your dose can be reduced gradually so you're less likely to get withdrawal symptoms.

If you stop using buprenorphine suddenly it can make you:

• feel agitated
• feel anxious
• shaky
• sweat a lot