Drug of the Day

A review of current practice and administration. Refer to Lexi-Comp for more detailed information.

Buprenorphine (Buprenex, Subutex, Butrans)

Guide to emergency department pain management with buprenorphine
Administration (Adults)

Administration/Monitoring

Precautions

AHS ED Indication

Administration

Adverse Drug Reactions

Sublingual tablets:
Place under the tongue until dissolved
If 2 or more tablets are needed per dose, can place all
under the tongue at once or 2 tablets at a time

In general, similar to other opioids:

Nervous system, respiratory, cardiovascular,
gastrointestinal, ocular, and dermatologic
reactions
Precipitated withdrawal
Rapid withdrawal symptoms can occur in
opioid dependent patients
Wait 12 hours after last dose of a short acting
opioid (e.g. heroin ) or 24 hours after last
dose of a long-acting opioid (e.g. MS Contin)
If patient is in objective moderate to severe
withdrawal, it is OK to give buprenorphine

Treatment of acute pain in patients with a

history of opioid/substance abuse not on
methadone. For these same patients,
buprenorphine can be continued upon
admission
OR as continuation of a home medication

Common ED Doses

Sublingual: 2-8mg x1
Injectable (IV or IM): 0.3mg x1
Transdermal: 5-20mcg/h

Oftentimes the injectable or sublingual dose can be

followed by a transdermal dose

Monitoring
Same monitoring as with any other opioid; watch for
respiratory depression, and hypotension

Injectable:
IV push over at least 2 minutes
Administer by deep IM injection
Transdermal Patch: (patient should stop other opioids)
Slow onset; low risk of precipitating withdrawal in most
cases. May need bridge of analgesia for first 24 hours.
Clean area with water only and allow to dry completely
Examine patient for any old patches and remove
Ensure skin site is non-irritated and hairless
To apply: 1) Remove the protective backing 2) place
sticky side of the patch to the upper outer arm, upper
chest, upper back or side of the chest 3) firmly press and
hold patch in place for ~15 sec
Label patch with date, time, and initials

Contraindications

Hypersensitivity
May have cross-sensitivity with other opioids
High risk of precipitated withdrawal among
methadone users

Derex Louie PharmD, Tina Liu, PharmD, Andrew Herring, MD, JFProvinse, MS, RN 7/16 References: Lexi-Comp for buprenorphine accessed 6-28-16