Buprenorphine patches for pain: 3-, 4- and 7-day types

The NHS describes buprenorphine as a strong opioid medicine used mainly for moderate to severe pain, such as during or after an operation or a serious injury, or pain from cancer, and for other long-term pain when weaker painkillers have stopped working. It blocks pain signals between the brain and the rest of the body and eases the anxiety and stress that pain causes.

It is also used to treat drug dependency, but that is generally prescribed by a specialist and is separate from this guide. For pain it comes as patches, dissolving tablets and injections, the latter usually given in hospital.

Patches are slow-release and take up to a day or 2 to start working, but last longer, so they suit pain that lasts a long time. Tablets that dissolve in the mouth take about 1 to 2 hours, with each dose usually lasting 6 to 8 hours, and are for pain expected to be short-lived or for breakthrough pain. An injection into a vein works almost at once.

Doses are individual: they depend on what you are taking it for, how bad the pain is, how you responded to other painkillers, side effects and other medicines you take. Usually you start on a lower dose of another opioid such as morphine and are moved to the patch once pain is under control.

Because change days differ by product, read the leaflet and mark the date. Apply the patch to clean, dry, flat, undamaged skin on an easy-to-reach site such as the upper chest or upper arm, avoiding very hairy areas. Press for at least 30 seconds, do not cover it, and do not cut it unless a doctor has told you to. Wash your hands afterwards.

• Never apply more than 1 patch at a time unless your doctor tells you to; more than recommended could lead to a fatal overdose.

• Avoid strong heat or sunlight on the patch (long hot baths, saunas, electric blankets, hot water bottles), which can increase absorption.

• If a 7-day patch falls off, replace it on a different area but keep your usual change day and time. For 3- or 4-day patches, note when the replacement went on and change after a further 3 or 4 days.

• Fold used patches in half, sticky side inwards, and ask a pharmacist how to dispose of them. If a patch sticks to someone else, remove it straight away.

Common effects, in more than 1 in 100 people, are constipation (a laxative is often prescribed to prevent it), nausea or vomiting, sleepiness or tiredness, dizziness or vertigo, confusion, headaches, stomach pain, and itching or rashes. Sleepiness often eases within a week or two. Higher doses and other medicines with similar effects make side effects more likely.

Call a doctor or 111, and remove the patch, for unexplained muscle stiffness, or dizziness, tiredness or low energy that could signal low blood pressure. Call 999 for difficulty breathing, short shallow breathing, a fit or anaphylaxis.

Tell your doctor or pharmacist if you have had an allergic reaction to buprenorphine, have breathing difficulties, sleep apnoea, a heavy alcohol intake or addiction, a head injury, seizures, an irregular heartbeat, kidney or liver problems, low blood pressure, an impaired gut such as paralytic ileus, long-term constipation or myasthenia gravis, or are trying for a baby, pregnant or breastfeeding.

In pregnancy it may occasionally be used for severe or difficult pain, but a baby exposed near the end of pregnancy may have withdrawal such as drowsiness. It can be used while breastfeeding, ideally at low doses and briefly, without stopping breastfeeding suddenly. There is no evidence of an effect on fertility.

Tell your doctor about medicines for sleep, mental health including depression and anxiety, high blood pressure, sickness, allergy symptoms, infections including HIV, or seizures. It is safe with paracetamol, ibuprofen or aspirin. Alcohol worsens sleepiness and dizziness, so avoid it when starting.

Do not drive, cycle or use machinery if it makes you sleepy, blurry-eyed, dizzy or unable to concentrate. After more than a few weeks, do not stop suddenly: withdrawal can include agitation, anxiety, panic attacks, palpitations, poor sleep, shaking, sweating and body aches, and doctors reduce patch strength gradually, sometimes using morphine to taper more slowly.