Updated: 11 Aug 2009
BUTRANS 5, 10 and 20ug/h Transdermal Patch
Analgesics, opioids - Analgesic Patch
BuTrans 5 µg/h Each transdermal patch contains 5 mg buprenorphine. Area containing active substance: 6.25 cm2. Nominal release rate: 5 micrograms of buprenorphine per hour (over a period of 7 days). BuTrans 10 µg/h Each transdermal patch contains 10 mg buprenorphine. Area containing active substance: 12.5 cm2. Nominal release rate: 10 micrograms of buprenorphine per hour (over a period of 7 days). BuTrans 20 µg/h Each transdermal patch contains 20 mg buprenorphine. Area containing active substance: 25 cm2. Nominal release rate: 20 micrograms of buprenorphine per hour (over a period of 7 days). Beige coloured patch with rounded corners: Square patch marked: BuTrans 5 µg/h Rectangular patch marked: BuTrans 10 µg/h Square patch marked : BuTrans 20 µg/h
BuTrans 5 µg/h transdermal patch BuTrans 10 µg/h transdermal patch BuTrans 20 µg/h transdermal patch
BuTrans should be administered every 7th day.
Patients aged 18 years and over:
The lowest BuTrans dose (BuTrans 5 μg/h transdermal patch) should be used as the initial dose. Consideration should be given to the previous opioid history of the patient as well as to the current general condition and medical status of the patient.
During initiation and titration with BuTrans, patients should use the usual recommended doses of short-acting supplemental analgesics as needed until analgesic efficacy with BuTrans is attained.
The dose should not be increased before 3 days, when the maximum effect of a given dose is established. Subsequent dosage increases may then be titrated based on the need for supplemental pain relief and the patient's analgesic response to the patch.
To increase the dose, a larger patch should replace the patch that is currently being worn, or a combination of patches should be applied in different places to achieve the desired dose. It is recommended that no more than two patches are applied at the same time, regardless of the patch strength. A new patch should not be applied to the same skin site for the subsequent 3-4 weeks. Patients should be carefully and regularly monitored to assess the optimum dose and duration of treatment.
Conversion from opioids:
BuTrans can be used as an alternative to treatment with other opioids. Such patients should be started on the lowest available dose (BuTrans 5 μg/h transdermal patch) and continue taking short-acting supplemental analgesics during titration, as required.
BuTrans should be applied to non-irritated, intact skin of the upper outer arm, upper chest, upper back or the side of the chest, but not to any parts of the skin with large scars. BuTrans should be applied to a relatively hairless or nearly hairless skin site. If none are available, the hair at the site should be cut with scissors, not shaven.
If the application site must be cleaned, it should be done with clean water only. Soaps, alcohol, oils, lotions or abrasive devices must not be used. The skin must be dry before the patch is applied. BuTrans should be applied immediately after removal from the sealed sachet. Following removal of the protective layer, the transdermal patch should be pressed firmly in place with the palm of the hand for approximately 30 seconds, making sure the contact is complete, especially around the edges. If the edges of the patch begin to peel off, the edges may be taped down with suitable skin tape.
The patch should be worn continuously for 7 days.
Bathing, showering, or swimming should not affect the patch. If a patch falls off, a new one should be applied.
Duration of administration:
BuTrans should under no circumstances be administered for longer than absolutely necessary. If long-term pain treatment with BuTrans is necessary in view of the nature and severity of the illness, then careful and regular monitoring should be carried out (if necessary with breaks in treatment) to establish whether and to what extent further treatment is necessary.
After removal of the patch, buprenorphine serum concentrations decrease gradually and thus the analgesic effect is maintained for a certain amount of time. This should be considered when therapy with BuTrans is to be followed by other opioids. As a general rule, a subsequent opioid should not be administered within 24 hours after removal of the patch. At present, only limited information is available on the starting dose of other opioids administered after discontinuation of the transdermal patch.
Patients with fever or exposed to external heat:
While wearing the patch, patients should be advised to avoid exposing the application site to external heat sources, such as heating pads, electric blankets, heat lamps, sauna, hot tubs, and heated water beds, etc., as an increase in absorption of buprenorphine may occur. When treating febrile patients, one should be aware that fever may also increase absorption resulting in increased plasma concentrations of buprenorphine and thereby increased risk of opioid reactions.
Patients under 18 years of age:
As BuTrans has not been studied in patients under 18 years of age the use of BuTrans in patients below this age is not recommended.
No dosage adjustment of BuTrans is required in elderly patients.
No special dose adjustment of BuTrans is necessary in patients with renal impairment.
Buprenorphine is metabolised in the liver. The intensity and duration of its action may be affected in patients with impaired liver function. Therefore patients with hepatic insufficiency should be carefully monitored during treatment with BuTrans.
Patients with severe hepatic impairment may accumulate buprenorphine during BuTrans treatment. Consideration of alternate therapy should be considered, and BuTrans should be used with caution, if at all, in such patients.
BuTrans should be used with particular caution in patients with convulsive disorders, head injury, shock, a reduced level of consciousness of uncertain origin, intracranial lesions or increased intracranial pressure, or in patients with severe hepatic impairment.
Significant respiratory depression has been associated with buprenorphine, particularly by the intravenous route. A number of overdose deaths have occurred when addicts have intravenously abused buprenorphine, usually with benzodiazepines concomitantly. Additional overdose deaths due to ethanol and benzodiazepines in combination with buprenorphine have been reported.
BuTrans is not recommended for analgesia in the immediate post-operative period or in other situations characterised by a narrow therapeutic index or a rapidly varying analgesic requirement.
Controlled human and animal studies indicate that buprenorphine has a lower dependence liability than pure agonist analgesics. In humans limited euphorigenic effects have been observed with buprenorphine. This may result in some abuse of the product and caution should be exercised when prescribing to patients known to have, or suspected of having, a history of drug abuse.
As with all opioids, chronic use of buprenorphine can result in the development of physical dependence. Withdrawal (abstinence syndrome), when it occurs, is generally mild, begins after 2 days and may last up to 2 weeks. Withdrawal symptoms include agitation, anxiety, nervousness, insomnia, hyperkinesia, tremor and gastrointestinal disorders.
Serious adverse reactions that may be associated with BuTrans therapy in clinical use are similar to those observed with other opioid analgesics, including respiratory depression (especially when used with other CNS depressants) and hypotension.
The following undesirable effects have occurred:
Very common (1/10), common (1/100, <1/10), uncommon (1/1000, <1/100), rare (1/10,000, <1/1000), very rare (<1/10,000), not known (cannot be estimated from the available data).
Immune system disorders
Very rare: anaphylactic reaction, anaphylactoid reaction
Metabolism and nutrition disorders
Common: confusion, depression, insomnia, nervousness,
Uncommon: sleep disorder, restlessness, agitation, depersonalisation, euphoric mood, affect lability, anxiety, hallucinations, nightmares
Rare: psychotic disorder, decreased libido
Very rare: drug dependence, mood swings
Nervous system disorders
Very common: headache, dizziness, somnolence
Uncommon: sedation, dysgeusia, dysarthria, hypoaesthesia, memory impairment, migraine, syncope, tremor, abnormal co-ordination, disturbance in attention
Rare: balance disorder, speech disorder
Very rare: involuntary muscle contractions
Uncommon: dry eye, blurred vision
Rare: visual disturbance, eyelid oedema, miosis
Ear and labyrinth disorders
Uncommon: tinnitus, vertigo
Very rare: ear pain
Uncommon: angina pectoris, palpitations, tachycardia,
Uncommon: hypotension, circulatory collapse, hypertension, flushing
Respiratory, thoracic and mediastinal disorders
Uncommon: asthma aggravated, cough, hypoxia, rhinitis, wheezing, hyperventilation, hiccups
Rare: respiratory depression, respiratory failure
Very common: constipation, dry mouth, nausea, vomiting
Common: abdominal pain, diarrhoea, dyspepsia
Rare: diverticulitis, dysphagia, ileus
Rare: biliary colic
Skin and subcutaneous tissue disorders
Very common: pruritus, erythema
Common: rash, sweating, exanthema
Uncommon: dry skin, face oedema, urticaria
Very rare: pustules, vesicles
Musculoskeletal and connective tissue disorders
Uncommon: muscle cramp, myalgia, muscular weakness, muscle spasms
Renal and urinary disorders
Uncommon: urinary retention, micturition disorder
Reproductive system and breast disorders
Rare: erectile dysfunction, sexual dysfunction
General disorders and administration site conditions
Very common: application site pruritus, application site reaction
Common: tiredness, asthenia, pain, peripheral oedema, application site erythema, application site rash, chest pain
Uncommon: fatigue, influenza like illness, pyrexia, rigors, malaise, oedema, drug withdrawal syndrome
Rare: application site inflammation*
Uncommon: alanine aminotransferase increased, weight decreased
Injury, poisoning and procedural complications
Uncommon: accidental injury, fall
* In some cases delayed local allergic reactions occurred with marked signs of inflammation. In such cases treatment with BuTrans should be terminated.
Buprenorphine has a low risk of physical dependence. After discontinuation of BuTrans, withdrawal symptoms are unlikely. This may be due to the very slow dissociation of buprenorphine from the opioid receptors and to the gradual decrease of buprenorphine plasma concentrations (usually over a period of 30 hours after removal of the last patch). However, after long-term use of BuTrans, withdrawal symptoms similar to those occurring during opioid withdrawal, cannot be entirely excluded. These symptoms include agitation, anxiety, nervousness, insomnia, hyperkinesia, tremor and gastrointestinal disorders.
BuTrans is contra-indicated in:
- patients with known hypersensitivity to the active substance buprenorphine or to any of the excipients
- opioid dependent patients and for narcotic withdrawal treatment
- conditions in which the respiratory centre and function are severely impaired or may become so
- patients who are receiving MAO inhibitors or have taken them within the last two weeks
- patients suffering from myasthenia gravis
- patients suffering from delirium tremens.