Your doctor may have prescribed this medication for you for a long-term, severe pain that hasn't been relieved by other painkillers. This is not like a regular painkiller. That's why it's very important to know exactly how to use this patch, what it can do, and what you need to be careful about. Let's talk about that today.
What is this medicine called Buprenorphine?
Simply put, Buprenorphine is a medication that is used to control very severe, chronic pain. It is not used for sudden pain. It is a long-acting medication. It works by blocking the signals that our brain receives from pain. This medication belongs to a group of powerful painkillers called 'Opioids' . In Sri Lanka, it is available under the brand name `Butrans`.
Things you need to tell your doctor before using this patch
Before giving you this patch, your doctor should be aware of your complete health history. Be sure to tell them about any of the following conditions, especially:
| Status/habit | Description |
|---|---|
| Head and brain related problems | Conditions such as brain tumors, head injuries, and seizures. |
| Addictions | If you have had drug abuse or addiction or drink alcohol frequently. |
| Diseases of internal organs | Liver disease, gallbladder disease, pancreatic disease, low adrenal gland function. |
| Heart and respiratory system | Heart disease, irregular heartbeat, lung disease, asthma or other breathing problems. |
| Use of other medications | If you have taken a medicine from the `MAOI` group (e.g. Marplan, Nardil) within the last 14 days. |
| Other points | If you are pregnant, trying to become pregnant, or breastfeeding. If you have had an allergic reaction to buprenorphine or any other medicine, food, or dye. |
How exactly do I use this patch?
This is a patch that is applied externally to the skin. It is very important to follow the instructions for using it exactly.
1. Choosing a place: Choose a clean, dry, unbroken area of skin to apply the patch. The best places to apply the patch are the upper outer arm above the shoulder, the upper chest, the upper back, or the side of the chest. For someone who is mentally impaired, it is best to apply the patch to the upper back, as this can make it difficult for them to remove it themselves.
2. Skin cleansing: Wash the selected area with water only and dry it thoroughly. Never use soap, alcohol, or lotions. Doing so can cause more of the medicine to be absorbed into the body and be dangerous. If there is hair in the area, trim it with scissors, but do not use a razor.
3. Applying the patch: Remove the patch from its packaging and remove the protective tape on the sticky side. Do not cut or damage the patch. Doing so may result in an overdose , which can be life-threatening. Do not touch the sticky side with your fingers. Press the inside of your palm and hold it firmly against your skin for about 15 seconds. Then wash your hands thoroughly with soap and water.
4. Changing the patch: Only apply the new patch after removing the old one. Apply it to a different spot each time. Do not apply it to the same spot repeatedly.
5. If the patch comes off: If the edges of the patch start to come off, apply a strip of first aid tape along the edges. If there is a persistent problem with peeling, cover the patch with a see-through adhesive dressing only (e.g. Bioclusive, Tegaderm). Do not cover the patch with any other bandage or tape.
Keep away from children and pets!
Even a used patch may still contain medicine. It can be fatal if a child or pet puts it in their mouth or puts it on their body. Do not put the patch where children can see it. Also, do not call it a "sticker" or "tattoo." This may encourage children to imitate it.
What if I miss a dose?
If you forget to change your patch, apply a new one as soon as you remember. But if it is almost time for your next dose, apply it only then. Never use two doses at the same time.
Other things that may interact with this medicine (Interactions)
When using this patch, tell your doctor about all medications, vitamins, and herbal products you are taking, especially if you drink alcohol.
Some medications can interact with this patch and cause serious side effects. For example:
- Some medications for depression, anxiety, or sleep
- Some medicines for allergies, coughs, and colds (Antihistamines)
- Some antifungals (eg, ketoconazole) and antibiotics (eg, erythromycin)
- Some medications for epilepsy (eg, carbamazepine)
- Muscle relaxants
- Alcohol
This list is not complete, so it's safest to tell your doctor about all the medications you take.
Things to keep in mind when using the patch
- About pain: Tell your doctor if your pain doesn't go away, gets worse, or if you have new types of pain. Over time, the dose you were previously taking may no longer be enough to control your pain. This is called `Tolerance`. This is normal.
- Stopping the medication: Do not stop using the patch suddenly. Your body is dependent on this medication, so stopping it suddenly can cause severe withdrawal symptoms. This is not an addiction. If necessary, your doctor will gradually reduce the dose.
- Drowsiness and dizziness: This medicine may make you feel drowsy and dizzy. So, until you know how this affects you , do not drive or operate machinery. Do not get up from a sitting or standing position suddenly.
- Constipation: This is a common side effect of this medication. If you do not have a bowel movement for 3 days, talk to your doctor.
- Body temperature: This is very important. If your body gets hot, more medicine can be released from the patch, which can lead to a fatal overdose. So, tell your doctor if you have a fever. Don't take hot baths, stay in the sun, use saunas, or use heating pads. Avoid exercise that increases your body temperature.
- In case of an overdose: If you think you have taken too much of this medicine, go to the Emergency Department (ETU) immediately or call the National Poisons Information Centre at the Colombo National Hospital . Symptoms of an overdose include slow breathing, extreme drowsiness, and inability to wake up. Talk to your doctor about the life-saving medicine `Naloxone`, which is given in such cases.
What side effects might I experience?
Like any medicine, this one can have side effects. Some are serious, some are common.
| Side effects that should be reported to your doctor immediately | |
|---|---|
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Central nervous system depression (CNS depression) | Slow or shallow breathing, excessive sleepiness, unconsciousness, difficulty waking up. |
| Changes in heart rate | Fast or irregular heartbeat, dizziness, chest pain. |
| Symptoms of liver damage | Pain in the upper right abdomen, loss of appetite, yellowing of the skin or eyes, dark urine. |
| Usually not serious (but tell your doctor if it persists) | |
Constipation, dizziness, drowsiness, dry mouth, headache, nausea, vomiting, itching or redness where the patch is applied. | |
Take-Home Message
- The buprenorphine patch is a powerful medication for severe, chronic pain. Use it only on the advice of your doctor.
- When applying the patch, choose a clean, dry, unbroken area of skin, wash with water only, and apply it properly. Always apply and store out of the reach of children and pets.
- This medicine may cause drowsiness and dizziness. Therefore, avoid driving. Avoid drinking alcohol completely.
- Excessive heat (fever, hot water bath) can cause the patch to absorb too much medicine, which can be dangerous. Be very careful with this.
- If you experience any severe side effects such as difficulty breathing, excessive drowsiness, or unconsciousness, go to the Emergency Treatment Unit (ETU) immediately.
- Tell your doctor about all other medications you are taking.
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