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. 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 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.

a

DEA allows off- label use for pain management198.