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 disordera | 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 disordera | Subutex: 2 mg, 8 mg |
DEA, US Drug Enforcement Administration.
DEA allows off- label use for pain management198.