Buprenorphine

The text below is about the active substance Buprenorphine.

buprenorphine for pain

• Buprenorphine is a strong pain reliever.
• In case of severe pain and addiction to opiates (for example heroin or morphine-like painkillers). Sometimes with pain and itching in the last phase of life (palliative care).
• Tablet under the tongue works within half to 1 hour. Injection works faster. In case of pain and itching, the effect lasts for about 6 to 8 hours.
• Patch works after 1 to 3 days. The effect lasts from a few days to 1 week.
• For pain: use as long as you need and on a regular schedule. For example every 6 to 8 hours. In case of drug addiction treatment: stick to the tapering schedule that the doctor has drawn up for you.
• Constipation is common and can be serious. Prevent this by using a laxative daily. You may also experience other gastrointestinal complaints.
• Do not drive for the first 2 weeks due to drowsiness and dizziness. Then only if you no longer suffer from side effects.
• Watch out with alcohol. This can make you extra drowsy.
• With long-term use: risk of habituation. If you stop, you may have withdrawal symptoms. For example palpitations, chills, restlessness and nausea. By gradually taper off, you have much less chance of this.

What are the side effects of buprenorphine? What is buprenorphine used for?

• Buprenorphine is a morphine-like pain reliever (opiate). It has a strong analgesic effect.
• Doctors prescribe it for severe pain , such as after surgery or pain due to cancer. Doctors also prescribe it for severe itching in palliative care (end-of-life care) and for opiate addiction.

Pain

Cause

• A damaged part of the body sends a ‘message’ to the brain via sensory nerves. The brain responds to this by movement, for example pulling the hands away from a heat source, and with emotions, such as fear. In many situations these reactions are useful, but they are often no longer the case with illness, surgeries and previous injuries.

Pain

• relief Pain relief usually goes through a step-by-step plan. Painkillers such as paracetamol and ibuprofen are the first step in this. These are effective for many types of pain and have few side effects.
• If these do not work sufficiently (anymore), the doctor prescribes stronger painkillers. Second step agents are codeine and tramadol. Third-step agents are the morphine-like painkillers, such as morphine, fentanyl or oxycodone. If these do not help enough or cannot be used, the doctor can prescribe buprenorphine.
• If severe pain is expected, such as after some operations, the doctor will prescribe a strong pain reliever right away. This is then reduced after a few days and replaced by a less strong pain reliever.

Operation

• Buprenorphine ensures that the ‘message’ in the brain does not arrive or arrives less strongly. This will make you feel the pain less and react more slowly to it.Effect

Depending on the type of administration you will notice the effect:

• tablets for under the tongue: the action starts after half an hour to 1 hour;
• injection deep into a muscle: the effect starts after 15 to 30 minutes and is at its peak after 1 to 2 hours
• injection into a vein: after 15 to 30 minutes;
• plaster: depending on the brand: effect starts after 1 to 3 days

The tablets and injection usually last for 6 to 8 hours. The effect of the patch can last for several days, depending on the brand of patch.

Palliative care

• Palliative care is aimed at alleviating physical and mental discomforts in the final stage of life in people who are incurably ill.
• Buprenorphine is used to treat end-of-life pain. If other opiates no longer work properly, the doctor may prescribe buprenorphine. Especially the tablet under the tongue for breakthrough pain. Usually, in the final phase, a switch will be made to morphine in an infusion via a pump.
• Buprenorphine in patches is also used to combat the severe itching that can occur in the final stages of life.

Addiction

This drug is used to reduce the need for opiates, such as heroin, morphine and methadone.

Symptoms

• With an addiction to opiates, such as heroin, withdrawal symptoms (withdrawal symptoms) may occur when you stop. These symptoms are a feeling of illness, clammy and cold skin, sweating, goosebumps, a runny nose, diarrhea, abdominal cramps and muscle pain in the arms and legs. These complaints disappear when the drug is taken again. The need for it is called physical dependence.
• Furthermore, due to the ‘high’ feeling, a user continues to long for the drug very strongly. Because of the numbing effect on feeling, pain and discomfort, he puts everything aside and does everything to use it. Especially the mental dependence is very great.

Effect

• Buprenorphine reduces the withdrawal symptoms that occur when you stop taking opiates. Since it usually does not cause a ‘intoxication’, you can get used to its absence in this way. By gradually decreasing the amount of buprenorphine over a number of weeks, you can then withdraw.
• Sometimes buprenorphine is combined with naloxone. Naloxone is a drug that counteracts the action of opiates. It has been added to the combination to prevent people from injecting buprenorphine in order to experience an intoxication.

Effect

• This medicine does not have the same effect for everyone. In addition, it is very important to be well motivated to kick the habit. The use of buprenorphine includes psychotherapy and social counseling. It is also important to keep using this medicine consistently.

What are buprenorphine side effects?

In addition to the desired effect, this can cause drug side effects. This medication is available as sublingual tablets, patches, and injections.

The side effects depend on the administration and the application you are using this drug for. The main side effects are the following.

When used as an injection and as a tablet for under the tongue for pain

Sometimes (affects 10 to 30 in 100 people)

• Drowsiness , dizziness and very rarely sleepiness. This reduces your ability to react and concentrate, which increases the risk of accidents. Accidents can occur, for example: in traffic, when climbing a ladder, operating devices or during surveillance and control activities. But you are also more likely to fall if you have to get out of bed to go to the toilet at night.
• Gastrointestinal complaints, such as nausea, rarely vomiting and very rarely loss of appetite or diarrhea. Most of the time, these side effects pass as your body gets used to this drug. Do you still have problems after a few weeks? Then consult your doctor.

Rare (affects 1 to 10 in 100 people)

• Decreased blood pressure . Sometimes you may notice this from dizziness, especially when getting out of bed or a chair. This generally passes after a few days of getting used to this drug. If you feel dizzy, do not get out of bed or a chair too quickly. It is best to lie down for a while and put your legs a little higher, for example on a pillow. If this continues to bother you, talk to your doctor.
• Feeling dizzy , spinning sensation and very rarely ringing in the ears when used under the tongue .
• Constriction of the pupils and very rarely eye inflammation and double vision.
• Constipation (constipation) . If possible, consume high-fiber foods and drink plenty. Usually doctors prescribe a laxative with this drug. Consult your doctor if you have constipation due to buprenorphine.
• Sweating . This side effect usually clears up after a few days of getting used to this drug.
• Headache .

Very rare (affects less than 1 in 100 people)

• Psychological complaints , such as confusion, nervousness, depression, restlessness and delusions (hallucinations).
• Physical addiction may develop after prolonged use . This is because the body gets used to buprenorphine over time. If you suddenly stop taking buprenorphine you may experience withdrawal symptoms. You can prevent this by gradually phasing out the use.
• Difficulty speaking.
• Tingling or numbness in the hands or feet.
• Dry mouth . This will cause cavities in your teeth more quickly. Brush and floss extra well if you notice a dry mouth. You may want to have more frequent dental checks if you are taking this medication for several weeks. If you suffer from a dry mouth, you can stimulate the production of saliva with (sugar-free) chewing gum or by sucking on ice cubes. It also helps if you drink something with food or moisturize the food, for example with gravy or fruit puree.
• Difficulty urinating . This is especially important if you already have difficulty passing urine due to an enlarged prostate . Contact your doctor if you have problems urinating.
• Shortness of breath and difficulty in breathing . This only occurs at very high doses. If breathing becomes very slow and shallow, contact your doctor.
• Liver disorders. You may sometimes notice this by yellowing of the skin or the whites of the eyes and dark urine.
• Sleep apnea , a short period of respiratory arrest during sleep. This drug can cause sleep apnea. If you have had sleep apnea before, you may be more affected. Contact your doctor if you notice that you have nighttime seizures of gasping or if they get worse.
• Hypersensitivity to this drug. You will notice this as a rash, itching, hives, breathlessness, dizziness or fainting. This can manifest as ‘angioedema’: a swelling of the face, lips, mouth, tongue or throat. You can get very short of breath. Then contact your doctor immediately.
  If you are hypersensitive to this drug, do not use it again. Tell the pharmacist that you are hypersensitive to buprenorphine. The pharmacy team can then ensure that you do not receive it in the future.

When used as a tablet for under the tongue in opiate addiction

Sometimes (affects 10 to 30 in 100 people)

• Sleep problems, such as insomnia.
• Headache.
• Gastrointestinal complaints, such as nausea and rarely vomiting, stomach pain, diarrhea, flatulence or loss of appetite. Usually, this side effect will pass as your body gets used to this drug. If you still have this after a few weeks, see your doctor.
• Sweating . This side effect usually clears up after a few days of getting used to this drug.
• Physical addiction may develop after prolonged use . This is because the body gets used to buprenorphine over time. If buprenorphine is stopped suddenly you may experience withdrawal symptoms. You can prevent this by gradually phasing out the use.

Rare (affects 1 to 10 in 100 people)

• Constipation (constipation) . If possible, consume high-fiber foods and drink plenty. Usually doctors prescribe a laxative with this drug. Consult your doctor if you have constipation due to buprenorphine.
• Dry mouth . This will cause cavities in your teeth more quickly. Brush and floss extra well if you notice a dry mouth. You may want to have more frequent dental checks if you are taking this medication for several weeks. If you suffer from a dry mouth, you can stimulate the production of saliva with (sugar-free) chewing gum or by sucking on ice cubes. It also helps if you drink something with food or moisturize the food, for example with gravy or fruit puree.
• Flu-like symptoms , such as fever, sore throat, runny nose, cough and chills.
• Psychological complaints , such as restlessness, nervousness, anxiety, depression and very rarely delusions (hallucinations).
• Decreased blood pressure . Sometimes you may notice this from dizziness, especially when getting out of bed or a chair. This generally passes after a few days of getting used to this drug. If you feel dizzy, do not get out of bed or a chair too quickly. It is best to lie down for a while and put your legs a little higher, for example on a pillow. If this continues to bother you, talk to your doctor.
• Drowsiness . This reduces your ability to react and concentrate, which increases the risk of accidents. Accidents can occur, for example: in traffic, when climbing a ladder, operating devices or during surveillance and control activities. But you are also more likely to fall if you have to get out of bed to go to the toilet at night.
• Muscle and joint pain , muscle spasms, tremors and tingling or numbness in the hands or feet.
• Cardiac arrhythmias . You sometimes only notice this when you suddenly feel dizzy or when you get away for a while. Especially people with the heart rhythm disorder prolonged QT interval are more likely to do this. Do NOT use this medication if you have this heart rhythm disorder.
• Shortness of breath and very rarely difficulty in breathing . This only occurs at very high doses. If breathing becomes very slow and shallow, contact your doctor.
• Water retention (swollen ankles and hands).

Very rare (affects less than 1 in 100 people)

• Hypersensitivity to this drug. You will notice this as a rash, itching, hives, breathlessness, dizziness or fainting. Then contact a doctor immediately. In rare cases, swelling of the face, tongue, lips or throat develops. Therefore immediately notify a doctor.
  If you are hypersensitive to this drug, do not use it again. Tell the pharmacist that you are hypersensitive to buprenorphine. The pharmacy team can then ensure that you do not receive it in the future.
• Liver disorders. You may sometimes notice this by yellowing of the skin or the whites of the eyes and dark urine.

When used as a plaster for pain or itching

Regular (affects more than 30 in 100 people)

• Constipation (constipation) . If possible, consume high-fiber foods and drink plenty. Usually doctors prescribe a laxative with this drug. Consult your doctor if you have constipation due to buprenorphine.

Sometimes (affects 10 to 30 in 100 people)

• Headache .
• Decreased blood pressure . Sometimes you may notice this from dizziness, especially when getting out of bed or a chair. This generally passes after a few days of getting used to this drug. If you feel dizzy, do not get out of bed or a chair too quickly. It is best to lie down for a while and put your legs a little higher, for example on a pillow. If this continues to bother you, talk to your doctor.
• Drowsiness and less often fatigue and sleepiness. This reduces your ability to react and concentrate, which increases the risk of accidents. Accidents can occur, for example: in traffic, when climbing a ladder, operating devices or during surveillance and control activities. But you are also more likely to fall if you have to get out of bed to go to the toilet at night.
• Gastrointestinal complaints, such as nausea and vomiting, rarely abdominal pain, diarrhea, loss of appetite and very rarely weight loss. Usually, this side effect will pass as your body gets used to this drug. If you still have this after a few weeks, see your doctor.
• Itching , rash , red skin and swelling at the site of the patch.

Rare (affects 1 to 10 in 100 people)

• Dry mouth . This will cause cavities in your teeth more quickly. Brush and floss extra well if you notice a dry mouth. You may want to have more frequent dental checks if you are taking this medication for several weeks. If you suffer from a dry mouth, you can stimulate the production of saliva with (sugar-free) chewing gum or by sucking on ice cubes. It also helps if you drink something with food or moisturize the food, for example with gravy or fruit puree.
• Psychological complaints , such as confusion, nervousness, anxiety, depression and very rarely restlessness, aggression, delusions (hallucinations) and mood changes.
• Sleep problems, such as insomnia and very rarely abnormal dreams (nightmares).
• Muscle weakness, tremors and very rarely muscle pain and muscle spasms .
• Shortness of breath and very rarely difficulty in breathing . This only occurs at very high doses. If breathing becomes very slow and shallow, contact your doctor.
• Sweating . This side effect usually clears up after a few days of getting used to this drug.
• Skin rash and very rarely hives . This may indicate hypersensitivity (see Very rare ).
• Water retention (swollen ankles and hands).

Very rare (affects less than 1 in 100 people)

• Hypersensitivity to this drug. You will notice this as a rash, itching, hives, breathlessness, dizziness or fainting. Then contact a doctor immediately. In rare cases, swelling of the face, tongue, lips or throat develops. Therefore immediately notify a doctor.
  If you are hypersensitive to this drug, do not use it again. Tell the pharmacist that you are hypersensitive to buprenorphine. The pharmacy team can then ensure that you do not receive it in the future.
• Sexual disturbances , such as less sex drive and difficult erection. Contact your doctor if you are affected.
• Taste disturbances , difficulty speaking, hiccups.
• Dry skin.
• Difficulty urinating . This is especially important if you already have difficulty passing urine due to an enlarged prostate . Contact your doctor as soon as you notice urinary problems.
• Chills , but also flushing and fever. Consult your doctor if this is a problem for you.
• Palpitations, increased heart rate, chest pain. Then notify a doctor.
• Blurred vision , dry eyes and narrowing of the pupils.
• Dizziness , feeling of spinning and very rarely ringing in the ears .

Consult your doctor if you experience too much of any of the above side effects, or if you experience any other side effects that worry you.

Do you suffer from any side effect? Report this to the lareb side effect center. All reports about side effects of medicines in the Netherlands are collected here.

Explanation of frequencies

• Regular : affects more than 30 in 100 people
• Uncommon : affects 10 to 30 in 100 people
• Rare : affects 1 to 10 in 100 people
• Very rare : affects less than 1 in 100 people

How do I take this medicine?

Always look for the correct dosage on the label of the pharmacy or in the package insert.

How?

Tablet for under the tongue

• Place the tablet under your tongue. Note: do not suck, bite or swallow the tablet.
• Keep the tablet under your tongue until the tablet is completely dissolved.
• You should not eat or drink anything while using the tablet. Before using the tablet, you may drink some water to moisten your mouth.

Band Aid

• Apply the patch to dry, non-irritated or damaged skin on the upper body, preferably in an area with as little hair as possible. Stick the patch in a different place each time . Choose a place for this that has not been used in the past 3 to 4 weeks.
• Make sure that the place where the patch is placed does not get too hot (not above 40 degrees Celsius). The active substance is released faster than normal due to heat, so that more side effects can occur.
• Do not use lotion or cream on the area where you will stick the patch. Fat makes the patch fall off. If patches keep falling off, you can stick the edges with a suitable skin tape if necessary. Ask your pharmacy for advice.

Injection

• The injection will usually be given by a nurse or doctor.

When?

• For pain and itching : it does not matter which times of use you choose this medicine. However, the doctor usually advises you to always use this medicine at the same times and not to wait until the symptoms increase again.
• You have to change a patch after a few days. Change the 3-day patch at the latest after 3 days and change the 4-day patch at the latest after 4 days. For convenience, you can change twice a week at fixed times, for example Monday evening and Friday morning.
• You should change the 7-day patch after 7 days at the latest. It is best to change the patch on a fixed day and time of the week, for example every Monday evening.
• In the case of addiction : choose a fixed time, then you will have less problems with withdrawal symptoms and you will forget a dose less quickly. Your doctor will indicate when you can start the drug addiction treatment. This depends on your personal circumstances.

How long?

• In case of pain: You can use the medicine as long as you are in severe pain. If your situation permits, your doctor will discuss with you whether tapering is possible and whether you can switch to a less potent pain reliever. If you take this medicine for several weeks, there is a chance that your body will get used to it. You should not suddenly stop taking buprenorphine. If you have been taking this medicine for several weeks, you should stop taking buprenorphine gradually. Then you will suffer less from the withdrawal symptoms.
• With drug addiction treatment : the amount of buprenorphine is usually gradually reduced over a few weeks. If you have been addicted for a long time, it is sometimes necessary to use buprenorphine for several months or more.

What if I miss a dose?

In case of pain and itching

Do you use the tablets for under the tongue or for injections ( if necessary up to 4 times a day)?

•  Use the forgotten dose. Then wait at least 6 hours before taking another dose.

Are you using the patches and have you forgotten to change the patch in time?

• Will you find out within 24 hours? Apply the new patch and stick to your normal schedule.
• Will you find out after 24 hours? Stick on the new patch and reschedule your schedule (if you find out after 2 days, for example, move your schedule from Monday evening-Friday morning to Wednesday evening-Sunday morning).

In drug addiction treatment

Do you use this medicine once a day? 

• Did you forget to take a dose and notice it the same day? Then take the dose. Do you only notice the next day? Skip the dose you missed.

Do you use this medicine once every 2 or 3 days? 

• Have you forgotten to take a dose? Then talk to your doctor.

Can I drive a car, drink alcohol, and eat or drink anything with this medicine?

driving a car?

• It can be dangerous to participate in traffic while taking this medicine. This is due to side effects such as drowsiness, confusion and dizziness. You should not drive for the first 2 weeks of taking this drug.
• After 2 weeks, most people have become sufficiently used to the effects. You may then drive again. But only do that if you no longer suffer from the side effects.

Please note: previous treatment for opiate addiction can also be a reason that you are not allowed to drive. Consult with your doctor if this is the case for you. Would you like more information about driving with certain conditions? Then take a look at the website of the CBR .

For more general information you can read the topic ‘ Medicines in traffic ‘. In this theme you can read, for example, what the law says about medicines in traffic. You will also find advice that you should take into account if you are allowed to drive (again).

drinking alcohol?

• Alcohol enhances the narcotic effect of this drug. Even if you no longer notice this because you have become used to buprenorphine, alcohol can make you very drowsy. Therefore, limit the use of alcohol and rather not drink it.

eat everything?

• There are no restrictions for this with this medication.

Can I use buprenorphine with other medications?

This drug interacts with other drugs. The text below only lists the active ingredients of these drugs, not the brand names. You can check whether your medicine contains one of these active substances in the package leaflet under the heading ‘composition’.

The drugs with which the main interactions occur are the following.

• Other drugs that reduce reaction time. These medicines often have a yellow warning sticker on the packaging . The effects on, for example, driving skills reinforce each other. Do not drive if you are taking 2 or more such drugs.
• Naltrexone and naloxone . These drugs counteract the effects of buprenorphine and other morphine-like painkillers. It can be used for this very reason, such as in the special under-tongue combination tablet of buprenorphine with naloxone.
  Naltrexone and naloxone are also used in people who are addicted to alcohol. People who use it for that reason should be aware that morphine-like painkillers are less effective for them. If you are already taking buprenorphine and you are receiving naltrexone or naloxone along with it, you may experience withdrawal symptoms.
• Other morphine-like pain killers. Sublingual buprenorphine and injections can reduce the effect of these painkillers. Sometimes that is the intention, namely in the case of addiction. However, if you use the combination for pain, you can have withdrawal symptoms. You can use the buprenorphine patches together with a fast-acting morphine-like pain reliever.
• Some medicines against HIV and hepatitis C . Ask your pharmacist which medicines this concerns.

Are you unsure whether any of the above interactions are of interest to you? Please contact your pharmacist or doctor.

Can I use this medicine if I am pregnant, planning to become or breastfeeding?

Pregnancy

• Tell your doctor and pharmacist as soon as you are pregnant or plan to become pregnant soon. Not enough is known about the use of this drug during pregnancy to know for sure whether it is safe. Therefore, weigh the severity of your complaints against the risk for the child together with your doctor.

DO NOT use this medication just before delivery . When used just before delivery, your child may have trouble breathing after birth. In addition, when used in the last 3 months of pregnancy, withdrawal symptoms may develop in the baby.

Breastfeeding

• You can safely use this drug for a short period of time if you are breastfeeding, for example for several days. This drug passes into breast milk in a very small amount.
• If you take this medicine for a longer period of time, your child may develop breathing problems. In addition, the flow of breast milk can be inhibited. Discuss this with your doctor.
• Are you on prescription or over-the-counter medicines? Would you like to help increase knowledge about medication use during pregnancy and breastfeeding? Then report your experience to pREGnant .