Drug Action
Buprenorphine is an opioid-receptor partial agonist (it has opioid agonist and antagonist properties).
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Drug reference
Buprenorphine is an opioid-receptor partial agonist (it has opioid agonist and antagonist properties).
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Moderate to severe pain ▶BY SUBLINGUAL ADMINISTRATION ▶Child (body-weight 16–25 kg): 100 micrograms every 6–8 hours ▶Child (body-weight 25–37.5 kg): 100–200 micrograms every 6–8 hours ▶Child (body-weight 37.5–50 kg): 200–300 micrograms every 6–8 hours ▶Child (body-weight 50 kg and above): 200–400 micrograms every 6–8 hours ▶Adult: 200–400 micrograms every 6–8 hours ▶BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION ▶Child 6 months–11 years: 3–6 micrograms/kg every 6–8 hours (max. per dose 9 micrograms/kg) ▶Child 12–17 years: 300–600 micrograms every 6–8 hours ▶Adult: 300–600 micrograms every 6–8 hours Premedication ▶BY SUBLINGUAL ADMINISTRATION ▶Adult: 400 micrograms ▶BY INTRAMUSCULAR INJECTION ▶Adult: 300 micrograms Intra-operative analgesia ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 300–450 micrograms Adjunct in the treatment of opioid dependence ▶BY SUBLINGUAL ADMINISTRATION USING SUBLINGUAL TABLETS ▶Adult: Initially 0.8–4 mg for 1 dose on the first day, adjusted in steps of 2–4 mg daily if required; usual dose 12–24 mg daily; maximum 32 mg per day ▶BY MOUTH USING ORAL LYOPHILISATE ▶Adult: Initially 2 mg daily, followed by 2–4 mg if required on day one, adjusted in steps of 2–6 mg daily if required, for adjustment of dosing interval following stabilisation, consult product literature; maximum 18 mg per day DOSE EQUIVALENCE AND CONVERSION ▶For opioid substitution therapy, in patients taking methadone who want to switch to buprenorphine, the dose of methadone should be reduced to a maximum of 30 mg daily before starting buprenorphine treatment— consult product literature. For sublingual tablets, if the dose of methadone is over 10 mg daily, buprenorphine can be started at a dose of 4 mg daily and titrated according to requirements; if the methadone dose is below 10 mg daily, buprenorphine can be started at a dose of 2 mg daily. BUTRANS ® Moderate, non-malignant pain unresponsive to non-opioid analgesics ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 5 micrograms/hour up to every 7 days, dose adjustments—when starting, analgesic effect should not be evaluated until the system has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of at least 3 days using a patch of the next strength or a combination of 2 patches applied in different places (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time BUPEAZE ® Moderate to severe chronic cancer pain in patients who have not previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have not previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 35 micrograms/hour up to every 96 hours, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time Moderate to severe chronic cancer pain in patients who have previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: The initial dose should be based on previous 24-hour opioid requirement, consult product literature, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time
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▶For Bupeaze ®: It may take approximately 30 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. BUPLAST ® Moderate to severe chronic cancer pain in patients who have not previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have not previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 35 micrograms/hour up to every 96 hours, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time Moderate to severe chronic cancer pain in patients who have previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have previously received strong opioid analgesic Nervous system ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: The initial dose should be based on previous 24-hour opioid requirement, consult product literature, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Buplast ®: It may take approximately 30 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. BUPRAMYL ® Moderate, non-malignant pain unresponsive to non-opioid analgesics ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 5 micrograms/hour up to every 7 days, dose adjustments—when starting, analgesic effect should not be evaluated until the system has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of at least 3 days using a patch of the next strength or a combination of 2 patches applied in different places (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Bupramyl ®: It may take approximately 12 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. BUTEC ® Moderate, non-malignant pain unresponsive to non-opioid analgesics ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 5 micrograms/hour up to every 7 days, dose adjustments—when starting, analgesic effect should not be evaluated until the system has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of at least 3 days using a patch of the next strength or a combination of 2 patches applied in different places (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Butec ®: It may take approximately 12 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. BUVIDAL ® Adjunct in the treatment of opioid dependence ▶BY SUBCUTANEOUS INJECTION ▶Adult: (consult product literature) ▶Weekly Buvidal ® has a terminal half-life ranging from 3 to 5 days. ▶Monthly Buvidal ® has a terminal half-life ranging from continued → 19 to 25 days. HAPOCTASIN ® Moderate to severe chronic cancer pain in patients who have not previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have not previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES Nervous system ▶Adult: Initially 35 micrograms/hour up to every 72 hours, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 72 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time, for breakthrough pain, consider 200–400 micrograms buprenorphine sublingually Moderate to severe chronic cancer pain in patients who have previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: The initial dose should be based on previous 24-hour opioid requirement, consult product literature, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 72 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time, for breakthrough pain, consider 200–400 micrograms buprenorphine sublingually ▶For Hapoctasin ®: It may take approximately 25 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. PANITAZ ® Moderate, non-malignant pain unresponsive to non-opioid analgesics ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 5 micrograms/hour up to every 7 days, dose adjustments—when starting, analgesic effect should not be evaluated until the system has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of at least 3 days using a patch of the next strength or a combination of 2 patches applied in different places (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Panitaz ®: It may take approximately 12 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. PRENOTRIX ® Moderate to severe chronic cancer pain in patients who have not previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have not previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 35 micrograms/hour up to every 72 hours, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 72 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time Moderate to severe chronic cancer pain in patients who have previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: The initial dose should be based on previous 24-hour opioid requirement, consult product literature, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 72 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Prenotrix ®: It may take approximately 25 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. RELETRANS ® Moderate, non-malignant pain unresponsive to non-opioid analgesics ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 5 micrograms/hour up to every 7 days, dose adjustments—when starting, analgesic effect should not be evaluated until the system has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of at least 3 days using a patch of the next strength or a combination of 2 patches applied in different places (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Reletrans ®: It may take approximately 12 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. RELEVTEC ® Moderate to severe chronic cancer pain in patients who have not previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have not previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 35 micrograms/hour up to every 96 hours, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time Moderate to severe chronic cancer pain in patients who have previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: The initial dose should be based on previous 24-hour opioid requirement, consult product literature, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Relevtec ®: It may take approximately 30 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. SEVODYNE ® Moderate, non-malignant pain unresponsive to non-opioid analgesics ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 5 micrograms/hour up to every 7 days, dose adjustments—when starting, analgesic effect should not be evaluated until the system has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of at least 3 days using a patch of the next strength or a combination of 2 patches applied in different places (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time ▶For Sevodyne ®: It may take approximately 12 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. TRANSTEC ® Moderate to severe chronic cancer pain in patients who have not previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have not previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: Initially 35 micrograms/hour up to every 96 hours, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time, for breakthrough pain, consider 200–400 micrograms buprenorphine sublingually Moderate to severe chronic cancer pain in patients who have previously received strong opioid analgesic | Severe pain unresponsive to non-opioid analgesics in patients who have previously received strong opioid analgesic ▶BY TRANSDERMAL APPLICATION USING PATCHES ▶Adult: The initial dose should be based on previous 24-hour opioid requirement, consult product literature, dose adjustment—when starting, analgesic effect should not be evaluated until the system has been worn for 24 hours (to allow for gradual increase in plasma-buprenorphine concentration)—if necessary, dose should be adjusted at intervals of no longer than 96 hours using a patch of the next strength or using 2 patches of the same strength (applied at same time to avoid confusion). Maximum 2 patches can be used at any one time, for breakthrough pain, consider 200–400 micrograms buprenorphine sublingually ▶For Transtec ®: It may take approximately 30 hours for the plasma-buprenorphine concentration to decrease by 50% after patch is removed. l UNLICENSED USE ▶With oral use in children Sublingual tablets not licensed for use in children under 6 years.
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GENERAL CAUTIONS Impaired consciousness SPECIFIC CAUTIONS ▶With transdermal use Fever or external heat. other opioids should not be administered within 24 hours of patch removal (long duration of action) ▶When used for adjunct in the treatment of opioid dependence Hepatitis B infection. hepatitis C infection. pre-existing liver enzyme abnormalities CAUTIONS, FURTHER INFORMATION ▶Fever or external heat ▶With transdermal use Manufacturer advises monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat (may also increase absorption). BUVIDAL ® Susceptibility to QT-interval prolongation
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Documentation of viral hepatitis status is recommended before commencing therapy for opioid dependence.
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Transdermal buprenorphine patches are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Transdermal patches are available as 72-hourly, 96-hourly and 7-day formulations; prescribers and dispensers must ensure that the correct preparation is prescribed and dispensed. Preparations that should be applied up to every 72 hours include Hapoctasin ® and Prenotrix ®. Preparations that should be applied up to every 96 hours include Bupeaze ®, Buplast ®, Relevtec ®, and Transtec ®. Preparations that should be applied up to every 7 days include Bupramyl ®, Butec ®, BuTrans ®, Panitaz ®, Reletrans ®, and Sevodyne ®. Espranor ® oral lyophilisate has different bioavailability to other buprenorphine products and is not interchangeable with them—consult product literature before switching between products.
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NICE decisions ▶Methadone and buprenorphine for the management of opioid dependence (January 2007) NICE TA114 ▶In adults Oral methadone and buprenorphine are recommended for maintenance therapy in the management of opioid dependence. Patients should be committed to a supportive care programme including a flexible dosing regimen administered under supervision for at least 3 months, until compliance is assured. Selection of methadone or buprenorphine should be made on a case-by-case basis, but methadone should be prescribed if both drugs are equally suitable. www.nice.org.uk/guidance/ta114 Scottish Medicines Consortium (SMC) decisions SMC No. 1213/17 ▶In adults The Scottish Medicines Consortium has advised (January 2017) that buprenorphine transdermal patches (Butec ®) are accepted for restricted use within NHS Scotland for the treatment of chronic non-malignant pain of moderate intensity when an opioid is necessary for obtaining adequate analgesia in elderly patients (over 65 years). SMC No. 1245/17 ▶In adults The Scottish Medicines Consortium has advised (June 2017) that buprenorphine oral lyophilisate (Espranor ®) is accepted for restricted use within NHS Scotland as substitution treatment for opioid dependence for patients in whom methadone is not suitable. This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower. SMC No. SMC2169 ▶In adults The Scottish Medicines Consortium has advised (August 2019) that buprenorphine (Buvidal ®) is accepted for restricted use within NHS Scotland for the treatment of opioid dependence in patients aged 16 years or over in whom methadone is not suitable and for whom the use of buprenorphine is considered appropriate. All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 3977 ▶In adults The All Wales Medicines Strategy Group has advised (September 2019) that buprenorphine prolonged- release solution for subcutaneous injection (Buvidal ®) is recommended as an option for use within NHS Wales for the treatment of opioid dependence in patients aged 16 years or over, within a framework of medical, social and psychological treatment.
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▶With transdermal use in adults Do not confuse the formulations of transdermal patches Nervous system which are available as 72-hourly, 96-hourly and 7-day patches, see Prescribing and dispensing information.
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→Appendix 1: opioids
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GENERAL SIDE-EFFECTS ▶Common or very common Anxiety. appetite decreased. depression. diarrhoea. dyspnoea. syncope. tremor SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With parenteral use Arthralgia (in adults). asthenia (in adults). asthma (in adults). behaviour abnormal (in adults). chest pain (in adults). chills (in adults). cough (in adults). dysmenorrhoea (in adults). eye disorders (in adults). fever (in adults). gastrointestinal discomfort (in adults). gastrointestinal disorders (in adults). hypersensitivity. increased risk of infection (in adults). insomnia (in adults). lymphadenopathy (in adults). malaise (in adults). migraine (in adults). muscle complaints (in adults). muscle tone increased (in adults). pain (in adults). paraesthesia (in adults). peripheral oedema (in adults). speech disorder (in adults). thinking abnormal (in adults). vasodilation (in adults). withdrawal syndrome neonatal. yawning (in adults) ▶With sublingual use Fatigue. sleep disorders ▶With transdermal use Asthenia. gastrointestinal discomfort. muscle weakness. oedema. sleep disorders ▶Uncommon ▶With parenteral use Procedural dizziness (in adults) ▶With sublingual use Apnoea. atrioventricular block. coma. conjunctivitis. coordination abnormal. cyanosis. depersonalisation. diplopia. dyspepsia. hypertension. pallor. paraesthesia. psychosis. seizure. speech slurred. tinnitus. urinary disorder ▶With transdermal use Aggression. chest pain. chills. circulatory collapse. concentration impaired. cough. dry eye. fever. gastrointestinal disorders. hiccups. hypertension. injury. memory loss. migraine. mood altered. movement disorders. muscle complaints. respiratory disorders. sensation abnormal. sexual dysfunction. speech impairment. taste altered. tinnitus. urinary disorders. vision blurred. weight decreased ▶Rare or very rare ▶With sublingual use Angioedema. bronchospasm ▶With transdermal use Angina pectoris. asthma exacerbated. dehydration. dysphagia. ear pain. eyelid oedema. increased risk of infection. influenza like illness. muscle contractions involuntary. psychotic disorder. vasodilation ▶Frequency not known ▶With parenteral use Angioedema. bronchospasm. death (in adults). hepatic disorders. hepatic encephalopathy (in adults). psychotic disorder. vision blurred ▶With sublingual use Cerebrospinal fluid pressure increased. Nervous system circulation impaired. haemorrhagic diathesis. hepatic disorders. oral disorders ▶With transdermal use Biliary colic. depersonalisation. seizure. withdrawal syndrome neonatal Overdose The effects of buprenorphine are only partially reversed by naloxone.
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Present in low levels in breast milk. Monitoring Neonates should be monitored for drowsiness, adequate weight gain, and developmental milestones.
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Manufacturer advises caution; avoid in severe impairment (limited information available). For transdermal patch, manufacturer advises consider avoiding in severe impairment. Dose adjustments For oral lyophilisate, manufacturer advises initial dose reduction in mild to moderate impairment.
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Avoid use or reduce dose; opioid effects increased and prolonged; increased cerebral sensitivity.
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Monitor liver function; when used in opioid dependence baseline liver function test is recommended before commencing therapy, and regular liver function tests should be performed throughout treatment.
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▶In children Sublingual tablets may be halved. ▶In adults Manufacturer advises oral lyophilisates should be placed on the tongue and allowed to dissolve. Patients should be advised not to swallow for 2 minutes and not to consume food or drink for at least 5 minutes after administration. BUTRANS ® Apply patch to dry, non-irritated, non-hairy skin on upper torso, removing after 7 days and siting replacement patch on a different area (avoid same area for at least 3 weeks). PRENOTRIX ® Manufacturer advises apply patch to dry, non-irritated, non-hairy skin on upper torso, removing after no longer than 72 hours and siting replacement patch on a different area (avoid same area for at least 7 days). HAPOCTASIN ® Apply patch to dry, non-irritated, non- hairy skin on upper torso, removing after no longer than 72 hours and siting replacement patch on a different area (avoid same area for at least 7 days). BUPRAMYL ®, BUTEC ®, PANITAZ ®, RELETRANS ®, SEVODYNE ® Manufacturer advises apply patch to dry, non-irritated, non-hairy skin on upper torso or upper outer arm, removing after 7 days and siting replacement patch on a different area (avoid same area for at least 3 weeks). TRANSTEC ® Apply patch to dry, non-irritated, non-hairy skin on upper torso, removing after no longer than 96 hours and siting replacement patch on a different area (avoid same area for at least 6 days). BUPEAZE ®, BUPLAST ®, RELEVTEC ® Manufacturer advises apply patch to dry, non-irritated, non-hairy skin on upper torso, removing after no longer than 96 hours and siting replacement patch on a different area (avoid same area for at least 7 days).
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Temgesic (Indivior UK Ltd) Buprenorphine (as Buprenorphine hydrochloride) 300 microgram per 1 ml Temgesic 300micrograms/1ml solution for injection ampoules | 5 ampoule P £2.46 c Sublingual tablet CAUTIONARY AND ADVISORY LABELS 2, 26 ▶Buprenorphine (Non-proprietary) Buprenorphine (as Buprenorphine hydrochloride) 400 microgram Buprenorphine 400microgram sublingual tablets sugar-free | 7 tablet P £1.72 DT = £1.36 c sugar-free | 50 tablet P £12.09 DT = £10.07 c Buprenorphine (as Buprenorphine hydrochloride) 2 mg Buprenorphine 2mg sublingual tablets sugar-free | 7 tablet P £8.35 DT = £4.61 c Buprenorphine (as Buprenorphine hydrochloride) 8 mg Buprenorphine 8mg sublingual tablets sugar-free | 7 tablet P £22.50 DT = £16.93 c ▶Natzon (Morningside Healthcare Ltd) Buprenorphine (as Buprenorphine hydrochloride) 400 microgram Natzon 0.4mg sublingual tablets sugar-free | 7 tablet P £1.60 DT = £1.36 c Buprenorphine (as Buprenorphine hydrochloride) 2 mg Natzon 2mg sublingual tablets sugar-free | 7 tablet P £6.35 DT = £4.61 c Buprenorphine (as Buprenorphine hydrochloride) 8 mg Natzon 8mg sublingual tablets sugar-free | 7 tablet P £19.05 DT = £16.93 c ▶Prefibin (Sandoz Ltd) Buprenorphine (as Buprenorphine hydrochloride) 400 microgram Prefibin 0.4mg sublingual tablets sugar-free | 7 tablet P £1.60 DT = £1.36 c Buprenorphine (as Buprenorphine hydrochloride) 2 mg Prefibin 2mg sublingual tablets sugar-free | 7 tablet P £5.38 DT = £4.61 c Buprenorphine (as Buprenorphine hydrochloride) 8 mg Prefibin 8mg sublingual tablets sugar-free | 7 tablet P £16.15 DT = £16.93 c ▶Subutex (Indivior UK Ltd) Buprenorphine (as Buprenorphine hydrochloride) 400 microgram Subutex 0.4mg sublingual tablets sugar-free | 7 tablet P £1.36 DT = £1.36 c Buprenorphine (as Buprenorphine hydrochloride) 2 mg Subutex 2mg sublingual tablets sugar-free | 7 tablet P £4.45 DT = £4.61 c Buprenorphine (as Buprenorphine hydrochloride) 8 mg Subutex 8mg sublingual tablets sugar-free | 7 tablet P £13.34 DT = £16.93 c ▶Temgesic (Indivior UK Ltd) Buprenorphine (as Buprenorphine hydrochloride) 200 microgram Temgesic 200microgram sublingual tablets sugar- free | 50 tablet P £5.04 DT = £5.04 c Buprenorphine (as Buprenorphine hydrochloride) 400 microgram Temgesic 400microgram sublingual tablets sugar- free | 50 tablet P £10.07 DT = £10.07 c ▶Tephine (Sandoz Ltd) Buprenorphine (as Buprenorphine hydrochloride) 200 microgram Tephine 200microgram sublingual tablets sugar-free | 50 tablet P £4.27 DT = £5.04 c Buprenorphine (as Buprenorphine hydrochloride) 400 microgram Tephine 400microgram sublingual tablets sugar-free | 50 tablet P £8.54 DT = £10.07 c Transdermal patch CAUTIONARY AND ADVISORY LABELS 2 ▶BuTrans (Napp Pharmaceuticals Ltd) Buprenorphine 5 microgram per 1 hour BuTrans 5micrograms/hour transdermal patches | 4 patch P £17.60 DT = £17.60 c Buprenorphine 10 microgram per 1 hour BuTrans 10micrograms/hour transdermal patches | 4 patch P £31.55 DT = £31.55 c Buprenorphine 15 microgram per 1 hour BuTrans 15micrograms/hour transdermal patches | 4 patch P £49.15 DT = £49.15 c Buprenorphine 20 microgram per 1 hour BuTrans 20micrograms/hour transdermal patches | 4 patch P £57.46 DT = £57.46 c ▶Bunov (Glenmark Pharmaceuticals Europe Ltd) Buprenorphine 5 microgram per 1 hour Bunov 5micrograms/hour transdermal patches | 4 patch P £5.54 DT = £17.60 c Buprenorphine 10 microgram per 1 hour Bunov 10micrograms/hour transdermal patches | 4 patch P £9.94 DT = £31.55 c Buprenorphine 20 microgram per 1 hour Bunov 20micrograms/hour transdermal patches | 4 patch P £18.10 DT = Nervous system £57.46 c ▶Bupeaze (Dr Reddy’s Laboratories (UK) Ltd) Buprenorphine 35 microgram per 1 hour Bupeaze 35micrograms/hour transdermal patches | 4 patch P £9.47 DT = £15.80 c Buprenorphine 52.5 microgram per 1 hour Bupeaze 52.5micrograms/hour transdermal patches | 4 patch P £13.99 DT = £23.71 c Buprenorphine 70 microgram per 1 hour Bupeaze 70micrograms/hour transdermal patches | 4 patch P £17.99 DT = £31.60 c ▶Buplast (Mylan) Buprenorphine 35 microgram per 1 hour Buplast 35micrograms/hour transdermal patches | 4 patch P £15.80 DT = £15.80 c Buprenorphine 52.5 microgram per 1 hour Buplast 52.5micrograms/hour transdermal patches | 4 patch P £23.71 DT = £23.71 c Buprenorphine 70 microgram per 1 hour Buplast 70micrograms/hour transdermal patches | 4 patch P £31.60 DT = £31.60 c ▶Bupramyl (Mylan) Buprenorphine 5 microgram per 1 hour Bupramyl 5micrograms/hour transdermal patches | 4 patch P £7.04 DT = £17.60 c Buprenorphine 10 microgram per 1 hour Bupramyl 10micrograms/hour transdermal patches | 4 patch P £12.62 DT = £31.55 c Buprenorphine 20 microgram per 1 hour Bupramyl 20micrograms/hour transdermal patches | 4 patch P £22.98 DT = £57.46 c ▶Butec (Qdem Pharmaceuticals Ltd) Buprenorphine 5 microgram per 1 hour Butec 5micrograms/hour transdermal patches | 4 patch P £7.92 DT = £17.60 c Buprenorphine 10 microgram per 1 hour Butec 10micrograms/hour transdermal patches | 4 patch P £14.20 DT = £31.55 c Buprenorphine 15 microgram per 1 hour Butec 15micrograms/hour transdermal patches | 4 patch P £22.12 DT = £49.15 c Buprenorphine 20 microgram per 1 hour Butec 20micrograms/hour transdermal patches | 4 patch P £25.86 DT = £57.46 c ▶Carlosafine (Glenmark Pharmaceuticals Europe Ltd) Buprenorphine 35 microgram per 1 hour Carlosafine 35micrograms/hour transdermal patches | 4 patch P £9.48 DT = £15.80 c Buprenorphine 52.5 microgram per 1 hour Carlosafine 52.5micrograms/hour transdermal patches | 4 patch P £14.23 DT = £23.71 c Buprenorphine 70 microgram per 1 hour Carlosafine 70micrograms/hour transdermal patches | 4 patch P £18.96 DT = £31.60 c ▶Hapoctasin (Accord Healthcare Ltd) Buprenorphine 35 microgram per 1 hour Hapoctasin 35micrograms/hour transdermal patches | 4 patch P £9.48 DT = £15.80 c Buprenorphine 52.5 microgram per 1 hour Hapoctasin 52.5micrograms/hour transdermal patches | 4 patch P £14.23 DT = £23.71 c Buprenorphine 70 microgram per 1 hour Hapoctasin 70micrograms/hour transdermal patches | 4 patch P £18.96 DT = £31.60 c ▶Panitaz (Dr Reddy’s Laboratories (UK) Ltd) Buprenorphine 5 microgram per 1 hour Panitaz 5micrograms/hour transdermal patches | 4 patch P £7.04 DT = £17.60 c Buprenorphine 10 microgram per 1 hour Panitaz 10micrograms/hour transdermal patches | 4 patch P £12.62 DT = £31.55 c Buprenorphine 20 microgram per 1 hour Panitaz 20micrograms/hour transdermal patches | 4 patch P £22.98 DT = £57.46 c ▶Reletrans (Sandoz Ltd) Buprenorphine 5 microgram per 1 hour Reletrans 5micrograms/hour transdermal patches | 4 patch P £6.34 DT = £17.60 c Buprenorphine 10 microgram per 1 hour Reletrans 10micrograms/hour transdermal patches | 4 patch P £11.36 DT = £31.55 c Buprenorphine 15 microgram per 1 hour Reletrans Nervous system 15micrograms/hour transdermal patches | 4 patch P £17.70 DT = £49.15 c Buprenorphine 20 microgram per 1 hour Reletrans 20micrograms/hour transdermal patches | 4 patch P £20.06 DT = £57.46 c ▶Relevtec (Sandoz Ltd) Buprenorphine 35 microgram per 1 hour Relevtec 35micrograms/hour transdermal patches | 4 patch P £11.06 DT = £15.80 c Buprenorphine 52.5 microgram per 1 hour Relevtec 52.5micrograms/hour transdermal patches | 4 patch P £16.60 DT = £23.71 c Buprenorphine 70 microgram per 1 hour Relevtec 70micrograms/hour transdermal patches | 4 patch P £22.12 DT = £31.60 c ▶Sevodyne (Aspire Pharma Ltd) Buprenorphine 5 microgram per 1 hour Sevodyne 5micrograms/hour transdermal patches | 4 patch P £5.53 DT = £17.60 c Buprenorphine 10 microgram per 1 hour Sevodyne 10micrograms/hour transdermal patches | 4 patch P £9.93 DT = £31.55 c Buprenorphine 20 microgram per 1 hour Sevodyne 20micrograms/hour transdermal patches | 4 patch P £18.09 DT = £57.46 c ▶Transtec (Napp Pharmaceuticals Ltd) Buprenorphine 35 microgram per 1 hour Transtec 35micrograms/hour transdermal patches | 4 patch P £15.80 DT = £15.80 c Buprenorphine 52.5 microgram per 1 hour Transtec 52.5micrograms/hour transdermal patches | 4 patch P £23.71 DT = £23.71 c Buprenorphine 70 microgram per 1 hour Transtec 70micrograms/hour transdermal patches | 4 patch P £31.60 DT = £31.60 c Oral lyophilisate CAUTIONARY AND ADVISORY LABELS 2 EXCIPIENTS: May contain Aspartame, gelatin ▶Espranor (Martindale Pharmaceuticals Ltd) Buprenorphine (as Buprenorphine hydrochloride) 2 mg Espranor 2mg oral lyophilisates sugar-free | 7 tablet P £6.35 DT = £6.35 c Buprenorphine (as Buprenorphine hydrochloride) 8 mg Espranor 8mg oral lyophilisates sugar-free | 7 tablet P £19.05 DT = £19.05 c Prolonged-release solution for injection ▶Buvidal (Camurus AB) Buprenorphine 50 mg per 1 ml Buvidal 16mg/0.32ml prolonged- release solution for injection pre-filled syringes | 1 pre-filled disposable injection P £55.93 DT = £55.93 c Buvidal 8mg/0.16ml prolonged-release solution for injection pre-filled syringes | 1 pre-filled disposable injection P £55.93 DT = £55.93 c Buvidal 24mg/0.48ml prolonged-release solution for injection pre- filled syringes | 1 pre-filled disposable injection P £55.93 DT = £55.93 c Buvidal 32mg/0.64ml prolonged-release solution for injection pre- filled syringes | 1 pre-filled disposable injection P £55.93 DT = £55.93 c Buprenorphine 355.56 mg per 1 ml Buvidal 96mg/0.27ml prolonged-release solution for injection pre-filled syringes | 1 pre- filled disposable injection P £239.70 DT = £239.70 c Buvidal 64mg/0.18ml prolonged-release solution for injection pre- filled syringes | 1 pre-filled disposable injection P £239.70 DT = £239.70 c Buvidal 128mg/0.36ml prolonged-release solution for injection pre- filled syringes | 1 pre-filled disposable injection P £239.70 DT = £239.70 c eiiii F 467
PDF pages 495, 496
Patients or carers should be given advice on how to administer buprenorphine products.
PDF page 494
200–400 micrograms every 6–8 hours
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
300–600 micrograms every 6–8 hours
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
400 micrograms
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
300 micrograms
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
300–450 micrograms
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
Initially 0.8–4 mg for 1 dose on the first day,
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
Initially 2 mg daily, followed by 2–4 mg if
First-line fragment. Read the complete Indications and Dose section above.
PDF page 490
Initially 5 micrograms/hour up to every 7 days,
First-line fragment. Read the complete Indications and Dose section above.
PDF page 491
Initially 35 micrograms/hour up to every
First-line fragment. Read the complete Indications and Dose section above.
PDF page 491
The initial dose should be based on previous
First-line fragment. Read the complete Indications and Dose section above.
PDF page 491