An opioid painkiller (also used in dependence)
Buprenorphine
An opioid painkiller, often given as a slow-release skin patch for ongoing pain; it can cause constipation, drowsiness and dependence and should not be stopped suddenly.
What is Buprenorphine?
Buprenorphine is an opioid painkiller used for moderate to severe long-lasting pain, and in other forms it is also used to treat opioid dependence. For pain it is often given as a skin patch that releases the medicine slowly over several days. Like other opioids it can cause constipation, drowsiness and dependence, so it is used carefully and reviewed regularly.
Education and reference only. This is a plain-language guide to Buprenorphine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Buprenorphine is an opioid analgesic used in the UK for moderate to severe pain that is not controlled by simpler painkillers, particularly persistent (chronic) pain where steady, round-the-clock cover is helpful. For pain it is most commonly supplied as a skin patch (for example BuTrans or Transtec) that releases the medicine gradually through the skin, avoiding the need for frequent tablets. It is also used, in separate higher-strength preparations, as part of treatment for opioid dependence. It relieves pain but does not treat the underlying cause, and it carries the recognised opioid risks of tolerance, dependence and side effects.
How it works
Buprenorphine acts on opioid receptors in the brain and spinal cord, the body's own pain-control system. By binding tightly to these receptors it dampens the pain signals reaching the brain and changes how pain is perceived, so pain feels less intense. Because of the way it attaches to the receptors it tends to give steady pain relief, which suits patch delivery; its action on opioid receptors elsewhere in the body explains side effects such as constipation, drowsiness and slowed breathing.
Company & origin
Originated / developed by: Originally developed by Reckitt & Colman (now part of Indivior) in the UK..
Buprenorphine was developed in the UK in the 1960s and 1970s and is now widely used both as a painkiller and, in higher-strength forms, in the treatment of opioid dependence.
Practical use
How to take Buprenorphine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- If you use a patch, apply it to clean, dry, hairless skin (such as the upper outer arm or upper chest) and press it firmly into place; choose a different site each time and avoid reusing the same spot for a while.
- Keep the patch away from direct heat sources such as hot baths, saunas, heat pads, electric blankets and strong sun, as heat raises absorption and the risk of too much medicine.
- Expect possible constipation and drowsiness; ask your pharmacist about a laxative, and do not drive or operate machinery if you feel sleepy or slowed.
- Do not drink alcohol or take other sedating medicines alongside it, as the combined drowsiness and slowed breathing can be dangerous.
- Do not stop suddenly after using it regularly — speak to your prescriber, who will reduce it gradually to avoid withdrawal.
- Fold used patches in half with the sticky sides together and dispose of them safely away from children and pets, as they still contain medicine.
Weighing it up
Advantages & disadvantages of Buprenorphine
Advantages
- Patch delivery gives steady, long-lasting pain relief without the need for frequent tablets, which many people find convenient.
- It is a useful option for persistent pain when round-the-clock cover is needed.
- It can be helpful for people who have difficulty swallowing tablets.
Disadvantages
- Like all opioids it can cause dependence and withdrawal, so it must not be stopped abruptly.
- Constipation and drowsiness are common, and the drowsiness can affect driving and concentration.
- Heat over the patch can raise absorption and cause overdose, so everyday warmth sources need to be avoided.
Practical use
Good to know
When used as a patch, it is applied to clean, dry, hairless skin and the site is rotated each time to reduce skin irritation. Heat increases how much medicine is absorbed, so avoid hot baths, saunas, heat pads, electric blankets or strong direct sun over the patch, as this can lead to too much being absorbed. It is an opioid, so it commonly causes constipation (which often does not wear off and may need a laxative) and can make you drowsy. With regular use the body becomes used to it, so it should not be stopped suddenly — it is reduced gradually to avoid withdrawal. It can affect driving: under UK drug-driving law it is an offence to drive if you are impaired, though you may drive if you are taking it as prescribed and are not impaired.
Who should not take it / use with caution
- People with severe breathing problems or an acute asthma attack.
- People who are dependent on or misusing alcohol or other sedating drugs, unless specifically managed by a specialist.
- Anyone who has had a serious allergic reaction to buprenorphine.
Monitoring
- Regular review of how well pain is controlled and whether the medicine is still needed.
- Watching for excessive drowsiness, breathing problems and signs of dependence.
- Checking the patch site for skin reactions and confirming patches are changed and disposed of correctly.
Side effects
- Constipation, which often persists and may need a laxative.
- Drowsiness, dizziness, nausea and headache, especially when starting.
- Skin redness or itching where a patch is applied.
- Slowed or shallow breathing, particularly with other sedatives or at higher exposure (seek urgent help).
Key interactions
- Other sedating medicines such as sleeping tablets, benzodiazepines, gabapentinoids and other strong opioids increase drowsiness and breathing risk.
- Alcohol adds to drowsiness and slowed breathing and should be avoided.
- Some medicines that affect liver enzymes can change buprenorphine levels, so tell your prescriber about all your medicines.
Available as: Skin patches for pain; separate preparations (such as tablets that dissolve under the tongue) are used in opioid dependence.
Answers
Buprenorphine: frequently asked questions
Why is buprenorphine often given as a patch?
The patch releases the medicine slowly and steadily through the skin over several days, giving continuous pain relief without frequent doses. This suits persistent pain and can help people who find it hard to swallow tablets.
Can I have a hot bath or use a heat pad with the patch on?
It is best to avoid direct heat over the patch. Heat increases how much medicine is absorbed, which can lead to too much getting into the body, so steer clear of hot baths, saunas, heat pads, electric blankets and strong direct sun on the patch.
Is buprenorphine addictive?
It is an opioid, so dependence can develop with regular use. Used as prescribed and reviewed by your team, the risk is managed, but you should not stop it suddenly; your prescriber will reduce it gradually if it is being stopped.
What should I do with a used patch?
Fold it in half with the sticky sides together and dispose of it safely, well out of reach of children and pets. Used patches still contain medicine and can be harmful if handled or swallowed by others.
Can I drive while using buprenorphine?
Under UK drug-driving law it is an offence to drive if your driving is impaired. You may drive if you are taking it as prescribed and feel unaffected, but do not drive if you feel drowsy, dizzy or slowed.
The wider class
About Opioid analgesics
Buprenorphine belongs to the opioid analgesics class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF
- NICE CKS
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.