. Author manuscript; available in PMC: 2022 Mar 1.

Published in final edited form as: Nat Rev Nephrol. 2021 Oct 7;18(2):113–128. doi: 10.1038/s41581-021-00484-6

Table 3 |.

Buprenorphine formulations used to treat chronic pain

Formulation	FDA-approved indication	Available strengths	Dosing	Conversions	Other considerations
Buprenorphine transdermal patch (Butrans)¹⁹⁴	Moderate-to- severe chronic pain	5, 7.5, 10, 15, 20 μg/h	Available as a 7-day patch Opioid-naive: 5 μg/h If switching from full agonist¹⁹⁵: 30–80 mg morphine equivalent (10 μg/h) For >80 mg morphine equivalent consider buprenorphine buccal film or sublingual buprenorphine Titration interval: minimum 72 h	Maximum dose 20 μg/h patch, which is equivalent to ~1 mg/day sublingual	Local dermatitis is common at the patch site and might respond to application of a thin film of topical steroid prior to patch application
Buprenorphine buccal film (Belbuca)¹⁹⁶	Moderate-to- severe chronic pain	75, 150, 300, 450, 600, 750, 900 μg	Opioid-naive: 75 μg daily or twice daily <30 mg morphine equivalent: 75 μg twice daily 30–89 mg morphine equivalent: 150 μg twice daily 90–160 mg morphine equivalent: 300 μg twice daily >160 mg morphine equivalent: use sublingual buprenorphine Titration interval: minimum 4 days	Buccal-to-sublingual dose ratio: 2:1	A buccal film combination buprenorphinenaloxone product (Bunavail) is FDA-approved for treatment of opioid use disorder
Buprenorphinenaloxone sublingual tablets or films (Suboxone and others)	Opioid use disorder^a	Suboxone: 2 mg/0.5 mg, 8 mg/2 mg	2–32 mg/day, typically divided doses when used off-label for pain management Individuals with comorbid opioid use disorder typically require higher daily doses (≥12–16 mg) to prevent opioid cravings	No dose adjustments needed when changing between combination and mono product If converting from sublingual tablets to sublingual films, dose reduction might be required as absorption might be increased	Although the DEA allows off-label use for pain, pharmacies and health insurers might have policies restricting its use for pain indication¹⁹⁷
Buprenorphine sublingual tablets or films (Subutex and others)	Opioid use disorder^a	Subutex: 2 mg, 8 mg

DEA, US Drug Enforcement Administration.

DEA allows off- label use for pain management¹⁹⁸.