Buprenorphine Transdermal Patch

Buprenorphine patches are used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. It is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

Transdermal buprenorphine comes as a patch to apply to the skin. The patch is usually applied to the skin once every 7 days. Change your patch at about the same time of day every time you change it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply buprenorphine patches exactly as directed.

Your doctor may start you on a low dose buprenorphine patch and gradually increase your dose, not more often than once every 3 days. If this increase involves the use of two patches, remove your current patch and at the same time, place the two new patches next to each other at a new site. If your doctor tells you to use two patches, you should always change and apply them at the same time. Your doctor may decrease your dose if you experience side effects. Contact your doctor if the dose you are taking does not control your pain. Talk to your doctor about how you are feeling during your treatment with buprenorphine patches.

Buprenorphine skin patches are only for use on the skin. Do not place patches in your mouth or chew or swallow the patches.

Do not stop using buprenorphine patches without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop using buprenorphine patches you may have symptoms of withdrawal. Call your doctor if you experience any of these symptoms of withdrawal: restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle aches, large pupils (black circles in the center of the eyes), irritability, diarrhea, nausea, vomiting, anxiety, pain in the joints, weakness, fast heartbeat, or rapid breathing.

Do not use a buprenorphine patch that is cut, damaged, or changed in any way. If you use cut or damaged patches, you may receive most or all of the medication at once, instead of slowly over 7 days. This may cause serious problems, including overdose and death.

If your buprenorphine patch is exposed to extreme heat, it may release too much medication into your body at once. This can cause serious or life-threatening symptoms.Do not expose your patch or the skin around it to direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated water beds. Do not take long, hot baths or sunbathe while you are wearing the patch.

You may bathe or shower while you are wearing a buprenorphine patch. If the patch falls off during these activities, dispose of it properly. Then dry your skin completely and apply a new patch. Leave the new patch in place for 7 days after you apply it.

You can apply a buprenorphine patch to your upper outer arms, upper chest, upper back, or the side of your chest. Choose an area of skin that is flat and hairless. Do not apply the patch to parts of the body that irritated, broken, cut, damaged, or changed in any way. If there is hair on the skin, use scissors to clip the hair as close to the skin as possible. Do not shave the area. Wait at least 3 weeks before applying a new patch to same site.

To apply the patch, follow these steps:

1. Clean the area where you plan to apply the patch with clear water and pat completely dry. Do not use any soaps, lotions, alcohols, or oils.

2. Use scissors to cut open the pouch containing the buprenorphine patch along the dotted line. Remove the patch from the pouch and peel off the protective liner from the back of the patch. Try not to touch the sticky side of the patch.

3. Immediately press the sticky side of the patch onto the chosen area of skin with the palm of your hand.

4. Press the patch firmly for at least 15 seconds. Be sure that the patch sticks well to your skin, especially around the edges. Do not rub the patch.

5. If the patch does not stick well or comes loose after it is applied, tape only the edges to your skin with first aid tape. If the patch still does not stick well, you may cover it with Bioclusive or Tegaderm brand see-through dressings. Do not cover the patch with any other type of bandages or tape. Talk to your doctor or pharmacist if your patch continues to have problems sticking to your skin.

6. If a patch falls off before it is time to remove it, dispose of the patch properly and apply a new patch at a different area of skin. Leave the new patch in place for 7 days.

7. When you are finished applying the patch, wash your hands with only clear water right away.

8. Write down the date and time that the patch is applied.

9. When it is time to change your patch, peel off the old patch and apply a new patch to a different skin area.

10. After you remove your patch, use the Patch Disposal Unit provided to you by the manufacturer to safely dispose of the used patch in the trash. Close the Patch Disposal Unit by folding the sticky sides together, then press firmly and smoothly over the entire Unit so that the patch is sealed within. Do not place used patches in the trash without first sealing them in the Patch Disposal Unit. Alternatively, you may also may fold the sticky sides of a used patch together and flush it down the toilet. Used patches may still contain some medication and may be dangerous to children, pets, or adults who have not been prescribed buprenorphine patches.

Buprenorphine should not be used to treat mild or moderate pain, short-term pain, or pain that can be controlled by medication that is taken as needed.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using buprenorphine patch,

• tell your doctor and pharmacist if you are allergic to buprenorphine, any other medications, or any of the ingredients in a buprenorphine patch. Ask your doctor or pharmacist or check the Medication Guide for a list of the ingredients.

• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take or use. Be sure to mention the medications listed in the IMPORTANT WARNING and any of the following medications: anticholinergics (atropine, belladonna, benztropine, dicyclomine, diphenhydramine, isopropamide, procyclidine, and scopolamine); cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); diuretics ('water pills'); certain medications for irregular heartbeat including amiodarone (Cordarone, Nexterone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), procainamide (Procanbid), quinidine (in Nuedexta), and sotalol (Betapace, Betapace AF, Sorine, Sotylize, others); lithium (Lithobid); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); certain medications for seizures such as carbamazepine (Tegretol, Teril, others), phenobarbital, phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); 5HT₃ serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pristiq), milnacipran (Savella), and venlafaxine (Effexor); trazodone; or tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Also tell your doctor or pharmacist if you are taking or receiving the following monoamine oxidase (MAO) inhibitors or if you have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Many other medications may also interact with buprenorphine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan.

• tell your doctor if you have or have ever had conditions mentioned in the IMPORTANT WARNING section or a paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to use buprenorphine patches.

• tell your doctor if you or an immediate family member have or have ever had prolonged QT syndrome (condition that increases the risk of developing an irregular heartbeat that may cause loss of consciousness, or sudden death); or if you have or ever had atrial fibrillation; heart failure; seizures; a head injury, a brain tumor, a stroke or any other condition that caused high pressure inside your skull; biliary tract disease; slowed heartbeat; low blood pressure; low blood levels of potassium; problems urinating; or pancreas, thyroid, heart, kidney, or liver disease.

• tell your doctor if you are breastfeeding.

• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using buprenorphine patches.

• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using a buprenorphine patch.

• you should know that this medication may make you drowsy. Do not drive a car, operate machinery, or do other possibly dangerous activities until you know how this medication affects you.

• you should know that buprenorphine patches may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start using a buprenorphine patch. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

• you should know that buprenorphine patches may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are using buprenorphine patches.

• you should know that if you have a fever or if you get very hot after physical activity, the amount of buprenorphine that you receive from the patch may increase and possibly cause an overdosage of medication. Avoid physical activity that might cause you to get very hot. Call your doctor right away if you have a fever. Your doctor may need to adjust your dose.

Unless your doctor tells you otherwise, continue your normal diet.

If you forget to apply or change a buprenorphine patch, apply the patch as soon as you remember it. Be sure to remove your used patch before applying a new patch. Wear the new patch for the period of time prescribed by your doctor (usually 7 days) and then replace it. Do not wear two patches at once unless your doctor has told you that you should.

• Buprenorphine patches may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • difficulty falling asleep or staying asleep

  • headache

  • dry mouth

  • stomach pain

  • skin irritation, itching, swelling, or redness in the area where you wore the patch

• Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

  • difficulty breathing or swallowing

  • shortness of breath

  • changes in heartbeat

  • agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea

  • nausea, vomiting, loss of appetite, weakness, or dizziness

  • inability to get or keep an erection

  • irregular menstruation

  • decreased sexual desire

  • chest pain

  • swelling of your face, tongue or throat

  • rash

  • hives

  • itching

• Buprenorphine patches may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

• If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Discard any patches that are outdated or as soon as they are no longer needed. Use a Patch Disposal Unit provided to you by the manufacturer to safely dispose of the unneeded or outdated patch(s) in the trash. Do not put unneeded or outdated buprenorphine patches in a garbage can without first sealing them in a Patch Disposal Unit. Alternatively, you may dispose of the patches by carefully removing the adhesive backing, folding the sticky sides of each patch together so that it sticks to itself, and flushing the patches down the toilet. Talk to your pharmacist about the proper disposal of your medication.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

While using buprenorphine patches, you should talk to your doctor about having a rescue medication called naloxone readily available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Symptoms of overdose may include the following:

• small, pinpoint pupils (black circles in the center of the eye)

• extreme sleepiness or drowsiness

• slowed or difficulty breathing

• unable to respond or wake up

Keep all appointments with your doctor and laboratory. Your doctor will order certain lab tests to check your body's response to buprenorphine.

Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are using buprenorphine.

Do not let anyone else use your medication. Buprenorphine is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.