Transdermal buprenorphine can be a safe and effective therapy for chronic pain if used properly.
Brand name: Butrans
Parameters:
(1) current MME per day
|
Current MME per day
|
Initial Dose in µg/hr
|
|
0 to 15
|
5.0 µg/hr
|
|
15 to 29
|
7.5 µg/hr
|
|
30 to 80
|
10 µg/hr
|
Pearls:
(1) The patch is applied once per week. A used patch must be removed.
(2) When starting therapy, the previous full agonist opioid can be given for one or two doses but it should then be stopped.
(3) Breakthrough pain can be treated with NSAIDs or an oral opioid.
(4) Titration should wait 7 days after starting or changing.
(5) A patch can be cut.
(6) Many insurance companies do not cover the cost.
(7) Do not stop before, during or after surgery/procedure.
(8) Skin irritation at the patch site can be reduced by pretreatment with steroid cream (nasal fluticasone).
(9) It does not require an XDEA number or additional training to prescribe.
