Buprenorphine is a prescription opioid medication. It’s a powerful pain reliever that’s also used to treat opioid use disorder (OUD).

Different forms of buprenorphine are approved for different uses, as follows:

  • Buprenorphine tablets are approved for use in adults to treat opioid dependence, which is now called OUD. (With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. With chronic misuse, misuse happens over and over.) With dependence, your body needs a drug in order for you to feel normal. Buprenorphine tablets are part of a complete treatment program for OUD that usually includes counseling or psychotherapy.
  • Buprenorphine injection is approved to manage severe pain in adults and children ages 2 years and older. It’s given by healthcare providers for short-term pain relief. For example, it may be given for pain that’s caused by surgery.*
  • Buprenorphine patches are used in adults to manage severe pain that needs continuous, long-term treatment with an opioid. They’re typically used to relieve chronic (ongoing) pain that’s caused by long-term conditions, such as cancer.*

For more information about these conditions and how buprenorphine is used for them, see the “Buprenorphine uses” section below.

*These forms of buprenorphine are used for pain relief when other pain medications aren’t suitable or don’t control pain well enough.

Drug details

Buprenorphine belongs to a class of drugs called partial opioid agonists. (A class of drugs is a group of medications that work in a similar way.)

Buprenorphine is a generic drug. It comes in the following forms and strengths:

  • Sublingual tablet (a pill that dissolves under your tongue). This form of the drug contains buprenorphine hydrochloride (HCl). It’s available in strengths of:
    • 2 mg (milligrams)
    • 8 mg
  • Liquid solution that’s given by healthcare providers as either intravenous (IV) injection or intramuscular (IM) injection. (An IV injection is given into a vein, while an IM injection is given into a muscle.) This form contains buprenorphine hydrochloride (HCl). It’s available in one strength, 0.3 mg per mL (milliliter).
  • Transdermal system, which is extended-release patches that are placed on your skin. This form of the drug is available in strengths of:
    • 5 mcg (micrograms) per hour (hr)
    • 7.5 mcg/hr
    • 10 mcg/hr
    • 15 mcg/hr
    • 20 mcg/hr

Generic buprenorphine has been available in other forms in the past. For example, it used to come as buccal films (films that dissolve between your gums and cheek). However, these films were discontinued. A combination of buprenorphine with another drug called naloxone is available as buccal film. To read more about this, see the “Buprenorphine use with naloxone” section below.

Other forms of buprenorphine that are only used in animals, not people, are also available. For example, buprenorphine SR is a form of buprenorphine that’s only approved for use in animals.

Brand-name versions

Brand-name versions of buprenorphine are available. These medications include:

  • Buprenex, which is an injection that’s used for short-term relief of severe pain
  • Butrans, which is an extended-release patch that’s used for long-term relief of severe pain
  • Belbuca, which is a buccal film that’s used for long-term relief of severe pain
  • Sublocade, which is an extended-release injection given under your skin that’s used for OUD

Is buprenorphine a controlled substance?

Yes, buprenorphine is a Schedule III controlled substance. This means that it has an accepted medical use, but it also has a high risk of being misused. (With misuse, a drug is taken in a way other than how it’s prescribed to be used.)

Schedule III drugs may cause physical or psychological dependence. (With dependence, your body needs a drug in order for you to feel normal.)

Doctors and pharmacists must follow special rules for prescribing and dispensing Schedule III controlled drugs. Your doctor or pharmacist can tell you more about these rules.

Also, it’s worth noting that people participating in competitive sports cannot use buprenorphine.

Effectiveness

For information about the effectiveness of buprenorphine, see the “Buprenorphine uses” section below.

Buprenorphine is a generic drug. A generic drug is an exact copy of the active drug in a brand-name medication. Buprenex injection, Butrans patch, and Subutex tablet (now discontinued), are the brand-name medications that different forms of buprenorphine are based on.

A generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using a brand-name medication instead of buprenorphine, talk with your doctor. They can tell you if the brand-name medication comes in forms and strengths that can be used for your condition. If you have insurance, you’ll also need to check whether your plan will cover the brand-name medication.

To learn more about how generics compare with brand-name drugs, see this article.

Buprenorphine is sometimes used with naloxone to treat opioid use disorder (OUD).

With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)

In fact, combination drugs containing both buprenorphine and naloxone are commonly prescribed for the long-term management of OUD.

Brand-name medications containing both buprenorphine and naloxone include:

  • Zubsolv, which comes as a sublingual tablet (a pill that dissolves under your tongue)
  • Suboxone, which comes as a:
    • sublingual film (a film that dissolves under your tongue)
    • buccal film (a film that dissolves between your gums and cheek)

Generic versions of these combination drugs are also available. (Generic medications are an exact copy of the active drugs in a brand-name medication.)

What naloxone is and why it’s used

Buprenorphine is an opioid. Naloxone, on the other hand, is an opioid blocker.

However, naloxone doesn’t have any effect if you take it by mouth. That’s because the body absorbs very little of this drug through your mouth. So, taking Suboxone, Zubsolv, or their generic versions by mouth will have the same effect as taking buprenorphine tablets alone by mouth.

Naloxone is included in Suboxone, Zubsolv, and similar drugs, to help prevent misuse of these medications.

People experiencing OUD may try to misuse forms of oral (taken by mouth) buprenorphine by dissolving and injecting them. In this way, people may try to achieve a “high.” But when injecting oral forms of buprenorphine that contain naloxone, the naloxone will quickly block the effect of buprenorphine. And this will cause immediate opioid withdrawal symptoms.

Misuse of a drug, including buprenorphine, can be dangerous and in some cases, life threatening. Be sure to use buprenorphine exactly how your doctor prescribes it for you.

Note: Naloxone is also available individually as a medication called Narcan. Narcan is a nasal spray that’s approved to treat opioid overdose. It’s available without a prescription from pharmacies. If you regularly take buprenorphine in any form, your healthcare provider may recommend that you have Narcan available in case of this emergency situation. To read more about using Narcan, see the “Buprenorphine overdose” section below.

Buprenorphine can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking buprenorphine. These lists do not include all possible side effects.

For more information about the possible side effects of buprenorphine, talk with your doctor or pharmacist. They can give you tips on how to deal with any concerning or bothersome side effects.

Note: The Food and Drug Administration (FDA) tracks the side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with buprenorphine, you can do so through MedWatch.

Mild side effects

Mild side effects* of buprenorphine can include:

  • nausea and vomiting
  • constipation
  • headache
  • drowsiness
  • dizziness
  • sweating
  • dry mouth
  • itching
  • sensations of burning or numbness in your mouth (for buprenorphine tablets only)
  • itching, redness, or rash at patch application site (for buprenorphine patches only)

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from buprenorphine. To learn about other mild side effects, talk with your doctor or pharmacist. You can also view the medication guide for buprenorphine patches or the prescribing information for buprenorphine injection or tablets.

Serious side effects

Serious side effects from buprenorphine aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Severe reactions where buprenorphine patches are applied. Symptoms can include:
    • severe skin redness, discoloration, or swelling
    • skin blistering
    • skin weeping
  • Liver problems, such as hepatitis (inflammation in your liver). Symptoms can include:
    • nausea and vomiting
    • pain in your upper right belly
    • yellowing of your skin or the whites of your eyes
  • Very low blood pressure. Symptoms can include:
    • dizziness, especially when rising after sitting or lying down
    • fainting
  • QT prolongation (a type of abnormal heart rhythm). Symptoms can include:
    • feeling that your heart is fluttering
    • dizziness
    • fainting
  • Addiction and misuse, including opioid use disorder (OUD).*†
  • Respiratory depression (slow, shallow, weak breathing).*†
  • Low levels of adrenal hormones.*
  • Allergic reaction.*
  • Neonatal opioid withdrawal syndrome, if buprenorphine is used during pregnancy.†‡

* For more information about this side effect, see “Side effect details” below.
† Buprenorphine injection and patches have a boxed warning from the FDA regarding this side effect. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.
‡ See the “Buprenorphine and pregnancy” section below for more information.

Side effects in children

Buprenorphine injection is approved to treat pain in children ages 2 years and older. However, buprenorphine patches and tablets are not approved for use in children.

Side effects of buprenorphine injection seen in children are similar to those seen in adults. These side effects are listed above and described below.

Side effect details

Here’s some detail on certain side effects this drug may cause.

Misuse and addiction

Buprenorphine is an opioid that has a high risk of misuse (also called abuse) and addiction.* With opioid misuse, a person takes an opioid in a way other than how it’s prescribed to be used. And with addiction, a drug is taken, even if it’s causing harmful outcomes.

It’s not known how often misuse of buprenorphine occurred during clinical studies.

It’s possible to develop dependency with buprenorphine use. (With dependence, your body needs a drug for you to feel normal.) And this can happen whether you take it for pain or for opioid use disorder (OUD).†

As a result of dependence, you can have withdrawal symptoms if you suddenly stop taking the drug. For buprenorphine, these symptoms can include muscle aches, sweating, and shaking.

* Buprenorphine injection and patches have a boxed warning from the FDA regarding this side effect. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.
† With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.). For more information about OUD and how buprenorphine is used to manage it, see the “Buprenorphine uses” section above.

What can be done

If you and your doctor decide you’re ready to stop taking buprenorphine, you’ll slowly stop taking it to avoid withdrawal symptoms. See the “Buprenorphine withdrawal and dependence” section below for more details.

If dependence develops with buprenorphine, it can cause you to crave higher or more frequent doses of the drug. It could also lead to misuse of buprenorphine or attempts to get access to buprenorphine or other opioids.

Your doctor will prescribe buprenorphine for pain management only after they’ve assessed your risk for OUD and misuse. Be sure to tell your doctor if you or any family members have experienced drug or alcohol misuse disorders. Also, tell your doctor if you or any family members have a mental illness, such as depression or have had one in the past. These factors may increase your risk for OUD and misuse of buprenorphine patches or injection.

If you take buprenorphine tablets to treat OUD, they will be part of a complete treatment program. This program will provide extra support to help you not misuse buprenorphine or other opioids.

If you have concerns about misuse, addiction, or dependence with buprenorphine, talk with your doctor. Also, because of buprenorphine’s high risk of misuse, you should keep it in a safe place to help prevent theft or misuse by others.

Respiratory depression

Buprenorphine can cause respiratory depression,* which is a serious breathing condition. With respiratory depression, you have slow, weak, and shallow breaths. Your breathing may even stop.

Respiratory depression can be severe, life threatening, and sometimes, even fatal.

It’s not known how often respiratory depression occurred in clinical studies of buprenorphine. However, certain factors increase your risk for this problem. These factors include:

  • being of older age
  • being weak or frail
  • overdose of buprenorphine (taking more buprenorphine than what’s prescribed for you)
  • misuse of buprenorphine (taking it in a way other than how it’s prescribed to be used)
  • taking buprenorphine with benzodiazepines, other central nervous system (CNS) depressants, or alcohol†

With respiratory depression, you may have symptoms of CNS depression (slowed brain activity), as well. These symptoms may include extreme sleepiness, confusion, slurred speech, or loss of consciousness.

* Buprenorphine injection and patches have a boxed warning from the FDA regarding this side effect. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.
† Buprenorphine injection and patch have a boxed warning from the FDA regarding side effects when these medications are used with CNS depressants. (CNS depressant are drugs that can cause CNS depression.) To read more about the risk of respiratory depression if buprenorphine is used with other drugs, see the “Buprenorphine interactions” section below.

What can be done

Your doctor will monitor you for the symptoms listed above, especially when you first take buprenorphine, or if your dosage is increased.

If you have symptoms of respiratory depression or CNS depression, call your doctor right away. But, call 911 or your local emergency number, or go to the nearest emergency room, if your symptoms feel life threatening or you think you’re having a medical emergency.

Note: Buprenorphine overdose can be treated with a nasal spray called Narcan. To read more about this medication, see the “Buprenorphine overdose” section below.

Low levels of adrenal hormones

Taking buprenorphine may cause low levels of adrenal hormones. This condition is also called adrenal insufficiency.

Adrenal insufficiency may occur with opioids, such as buprenorphine. This is because opioids can stop your adrenal glands from making enough of a hormone called cortisol.

It’s not known how often adrenal insufficiency occurred in clinical studies of buprenorphine. But, adrenal insufficiency is more likely to occur if you use opioids for longer than a month.

Having low levels of adrenal hormones can cause:

What can be done

If you have any of these symptoms while using buprenorphine, tell your doctor. They may order certain tests to check the health of your adrenal glands.

If the tests show that you have problems with your adrenal glands, you may need to take a steroid medication. You may also need to stop taking buprenorphine.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking buprenorphine. However, allergic reactions to buprenorphine were rare in clinical studies.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth, swelling, or redness or discoloration in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to buprenorphine, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

The buprenorphine dosage your doctor prescribes for you will depend on several factors. These include:

  • the type and severity of the condition you’re using buprenorphine to treat
  • your age
  • the form of buprenorphine you take
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Buprenorphine comes in the following forms and strengths:

  • Sublingual tablet (a pill that dissolves under your tongue). This form of the drug contains buprenorphine hydrochloride (HCl). It’s available in strengths of:
    • 2 mg (milligrams)
    • 8 mg
  • Liquid solution that’s given by healthcare providers as either intravenous (IV) injection or intramuscular (IM) injection. (An IV injection is given into a vein, while an IM injection is given into a muscle.) This form contains buprenorphine hydrochloride (HCl). It’s available in one strength, 0.3 mg per ml (milliliter).
  • Transdermal system, which is extended-release patches that are placed on your skin. (Extended-release patches release a certain amount of the drug into your body over a specific length of time.) This form of the drug is available in strengths of:
    • 5 mcg (micrograms) per hour (hr)
    • 7.5 mcg/hr
    • 10 mcg/hr
    • 15 mcg/hr
    • 20 mcg/hr

Dosage for pain

Buprenorphine injection and patches are approved to treat pain. Typical dosages for these forms of the drug are described below.

Dosage of buprenorphine injection for pain

The usual dosage of buprenorphine injection for adults and children ages 12 years and older is 0.3 mg. This injection is administered by either:

  • IM injection, or
  • IV injection that’s given over at least 2 minutes

A second injection may be given 30 to 60 minutes later, if needed.

Buprenorphine injections may be given every 6 hours, as needed.

Dosage of buprenorphine patch for pain

For buprenorphine patches, the recommended starting dosage depends on whether you’ve already been taking other opioid pain relievers.

For instance:

  • Adults who haven’t been taking other opioids will usually start by using one 5 mcg/hr patch applied once every 7 days.
  • Adults who have been taking other opioids may start by using one 5 mcg/hr patch or one 10 mcg/hr patch applied once every 7 days.

Which patch a person uses depends on the dose of the opioids they were previously taken. When starting buprenorphine patches, you’ll stop the other opioids and apply your first buprenorphine patch when your next opioid dose is due.

Your doctor may gradually increase the strength of buprenorphine patch you use until you reach the dosage that’s right for you. This is the dosage that controls your pain but causes minimum side effects. However, you shouldn’t make any dosage changes until you’ve worn a buprenorphine patch for at least 72 hours.

The maximum recommended dosage for buprenorphine patch is 20 mcg/hr.

Dosage for opioid dependence

Buprenorphine tablets are used for opioid dependence, which is now called opioid use disorder (OUD).* With dependence, your body needs a drug in order for you to feel normal.

Buprenorphine tablets are typically used for the induction (starting) phase of OUD treatment. And sometimes they’re used for the maintenance (long-term) phrase of OUD treatment.

* With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.). For more information about OUD and how buprenorphine is used to manage it, see the “Buprenorphine uses” section above.

Dosage of buprenorphine tablets for induction phase treatment

The buprenorphine dosage your doctor prescribes for induction treatment will depend on:

A typical starting dosage for buprenorphine tablets is 2 mg to 8 mg per day. You’ll take your first dose when you start to have withdrawal symptoms after stopping other opioids.

Typically, you shouldn’t take your first dose of buprenorphine until at least 4 hours after you last took a short-acting opioid, such as heroin. And you shouldn’t take buprenorphine until at least 24 hours after you last took a long-acting opioid, such as methadone. Your doctor will explain what dosage of buprenorphine to take and when to take it.

If your opioid withdrawal symptoms aren’t managed on the first day of buprenorphine induction treatment, your doctor will likely increase your buprenorphine dose the following day. And they’ll continue to adjust your buprenorphine dosage until your withdrawal symptoms are managed.

Dosage of buprenorphine tablets for maintenance phase treatment

Sometimes buprenorphine tablets are used for maintenance treatment of OUD. For this use, your doctor will prescribe the lowest possible buprenorphine dosage that manages your opioid withdrawal symptoms and cravings.

The suggested dosing range of buprenorphine tablets for maintenance phase OUD treatment is 4 mg to 24 mg taken once a day.

However, buprenorphine is typically used with naloxone for maintenance treatment. For more information about this combination of drugs, see the “Buprenorphine use with naloxone” section above.

Children’s dosage

Buprenorphine injection is approved for pain treatment in children ages 2 years and older.

The recommended dosage of buprenorphine injection in children ages 2 to 12 years is based on the child’s body weight. The usual dose is 2 to 6 micrograms (mcg) of drug per kilogram (kg) of body weight. And this dose is given by either IV or IM injection once every 4 to 6 hours.

The recommended dosage of buprenorphine injection for pain in children ages 12 years and older is the same as in adults. This dosage is described above in the “Dosage for pain” section.

Buprenorphine patches and tablets are not approved for use in children.

What if I miss a dose?

What you’ll do for a missed dose of buprenorphine depends on which form of the drug you’re using. For instance:

  • If you miss a dose of buprenorphine patch by forgetting to change your patch after 7 days, you should apply a new patch as soon as possible. You may have increased pain or buprenorphine withdrawal symptoms until the new patch starts to work. Talk with your doctor right away if you forget to change your buprenorphine patch. They can recommend ways to manage any problems you have. And never apply more patches than usual to make up for not changing your patch on time.
  • If you miss a dose of buprenorphine tablets, take the missed dose as soon as possible, unless it’s nearly time for your next dose. In this case, just skip the missed dose and take your next dose when it’s due. Don’t take two doses together to make up for missing a dose, unless your doctor tells you to.
  • You’re not likely to miss a dose of buprenorphine injection. This is because healthcare providers administer this form of the drug .

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

How long your doctor recommends that you take buprenorphine depends on which form of the drug you’re using and why you’re taking it.

For example:

  • Buprenorphine patches are meant to be used as a long-term treatment for pain. If you and your doctor determine that buprenorphine patch is safe and effective for you, you’ll likely use it for as long as you need it to control your pain.
  • Buprenorphine injection is meant to be used as a short-term treatment for pain. If you need longer-term pain management, your doctor will recommend an appropriate treatment option.
  • Buprenorphine tablets are typically used short-term at the start of OUD treatment. But, they may sometimes be used for long-term maintenance treatment as well. In this case, if you and your doctor determine that it’s safe and effective for you, you’ll likely use it for as long as you continue to need it.

You shouldn’t drink alcohol while you’re taking buprenorphine.*

Drinking alcohol increases the risk of serious side effects with buprenorphine. These side effects include:

Symptoms of CNS depression can include:

  • extreme sleepiness or sedation
  • respiratory depression
  • blurred vision
  • slurred speech
  • confusion
  • problems with coordination
  • slowed reflexes
  • dizziness or fainting
  • coma
  • in some cases, death

If you are concerned about avoiding alcohol while using buprenorphine, talk with your doctor.

* Buprenorphine injection and patches have a boxed warning from the FDA regarding risks if these medications are used with alcohol. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Buprenorphine can interact with several other medications. It can also interact with certain supplements.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Buprenorphine and other medications

Below is a list of medications that can interact with buprenorphine. This list does not contain all drugs that may interact with buprenorphine.

Before taking buprenorphine, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Types of drugs that can interact with buprenorphine include:

  • Benzodiazepines and other central nervous system (CNS) depressants.* These are drugs used to reduce anxiety, relax muscles, or help with sleep. (CNS depressants slow the activity of your brain.) Taking buprenorphine with these drugs can increase your risk for extreme drowsiness or sedation, respiratory depression (slow, shallow breathing), coma, and even death. Examples of these drugs include:
    • alprazolam (Xanax)
    • clonazepam (Klonopin)
    • diazepam (Valium)
    • lorazepam (Ativan)
    • eszopiclone (Lunesta)
    • zaleplon (Sonata)
    • zolpidem (Ambien)
    • baclofen (Ozobax, Lioresal)
    • tizanidine (Zanaflex)
  • Other opioids. Taking buprenorphine with other opioids can increase the risk of extreme drowsiness or sedation, respiratory depression, coma, and even death.* Buprenorphine can also make opioid pain relievers less effective at relieving pain. And if you’re physically dependent on other opioids, taking buprenorphine can cause opioid withdrawal symptoms. (With dependence, your body needs a drug in order for you to feel normal.) Examples of other opioids include:
    • dihydrocodeine
    • heroin
    • hydrocodone (the opioid in Norco)
    • fentanyl (Duragesic, Subsys, Lazanda, Fentora, and others)
  • Certain antidepressants. Taking buprenorphine with certain antidepressants can increase your risk of a serious side effect called serotonin syndrome. (Serotonin syndrome is caused by high levels of the chemical serotonin in your brain.) Examples of these antidepressants include:
    • amitriptyline
    • desipramine (Norpramin)
    • imipramine (Tofranil)
    • phenelzine (Nardil)
    • isocarboxazid (Marplan)
    • tranylcypromine (Parnate)
    • mirtazapine (Remeron)
    • trazodone
  • Triptans. Triptans are drugs used to treat migraine. Taking buprenorphine with triptans can increase your risk of a serious side effect called serotonin syndrome. Examples of triptans include:
    • almotriptan
    • frovatriptan (Frova)
    • naratriptan (Amerge)
    • zolmitriptan (Zomig)
  • Drugs that are CYP3A4 inhibitors. CYP3A4 is an enzyme (type of protein) in your liver that helps your body metabolize (break down) certain drugs, including buprenorphine. Drugs that are CYP3A4 inhibitors can stop this enzyme from working properly. Taking buprenorphine with these drugs can increase your risk for side effects with buprenorphine. Examples of these drugs include:
    • certain antibiotics, such as clarithromycin and erythromycin
    • certain antifungals, such as ketoconazole and itraconazole (Sporanox)
    • certain HIV medications, such as atazanavir (Reyataz) and cobicistat (Tybost)
    • the antidepressant nefazodone
  • Drugs that are CYP3A4 inducers. CYP3A4 is an enzyme (type of protein) in your liver that helps your body metabolize (break down) certain drugs, including buprenorphine. Drugs that are CYP3A4 inducers can increase the activity of this enzyme. Taking buprenorphine with these drugs can make buprenorphine less effective. In people with buprenorphine dependency, doing so can also cause withdrawal symptoms. (With dependence, your body needs a drug in order for you to feel normal.) Examples of these drugs include:
    • certain antimicrobials, such as rifabutin (Mycobutin) and rifampin (Rifadin)
    • certain seizure medications, such as carbamazepine (Carbatrol, Equetro, Tegretol) and fosphenytoin (Cerebyx)
  • Drugs that can cause QT prolongation. QT prolongation is a type of abnormal heart rhythm. Taking buprenorphine patches or injection with drugs that can cause this condition may increase your risk of QT prolongation. Examples of these drugs include:
    • certain drugs for irregular heartbeats, such as amiodarone (Pacerone) and quinidine
    • certain antipsychotic drugs, such as pimozide and haloperidol

* Buprenorphine injection and patches have a boxed warning from the FDA regarding this interaction. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Buprenorphine and herbs and supplements

Taking the herb St. John’s wort with buprenorphine may lower the level of buprenorphine in your body. And this could make buprenorphine less effective. Also, in people with buprenorphine dependency, doing so can cause lead to buprenorphine withdrawal symptoms. (With dependence, your body needs a drug in order for you to feel normal.)

You shouldn’t use St. John’s wort with buprenorphine. And be sure to check with your doctor or pharmacist before using any other herbs or supplements while taking buprenorphine.

Buprenorphine and foods

There aren’t any foods that have been specifically reported to interact with buprenorphine. If you have any questions about eating certain foods with buprenorphine, talk with your doctor.

This drug comes with several precautions.

FDA warnings for buprenorphine patch and injection

Buprenorphine patches and injection have boxed warnings. These warnings are the most serious warnings from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Addiction and misuse (also called abuse)

Buprenorphinepatches and injection carry a risk of causing opioid use disorder (OUD). With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)

OUD can include opioid dependence and addiction. (With dependence, your body needs a drug in order for you to feel normal. And with addiction, a drug is taken, even if it’s causing harmful outcomes.

OUD can develop with recommended doses or misuse of buprenorphine. OUD and misuse of opioids can lead to opioid overdose and in some cases, death.

Your doctor will assess your risk for OUD and opioid misuse before prescribing buprenorphine for pain relief. Be sure to tell your doctor if you or any family members have experienced drug or alcohol misuse disorders. Also tell your doctor if you or any family members have a mental illness, such as depression, or have had one in the past. These factors may increase your risk for OUD and misuse of buprenorphine patches or injection.

Opioid analgesic risk management and mitigation strategy (REMS)

The FDA requires that the manufacturer of buprenorphine patches provides a REMS educational program for healthcare providers. This requirement is due to the risk ofOUD and opioid misuse with buprenorphine patches.

The buprenorphine REMS program helps train healthcare providers to give advice about using buprenorphine patches in a safe and effective way. This helps ensure that the drug’s benefits outweigh its risks when it’s prescribed.

Life-threatening respiratory depression

Buprenorphine can cause severe, life threatening, or even fatal respiratory depression. (With respiratory depression, you have slow, shallow, and weak breathing).

Your doctor will monitor you for this condition. This is especially important when you first start using buprenorphine or when your dosage is increased.

Do not misuse buprenorphine patches by swallowing, chewing, snorting, or injecting drug extracted from the patches. Doing so can lead to buprenorphine overdose, and even death, from respiratory depression.

Accidental exposure to buprenorphine patch

Being exposed to buprenorphine patches on accident can cause buprenorphine overdose, and even death. And this is possible even with just one dose of buprenorphine. Children are especially at risk for accidental exposure.

Be sure to keep buprenorphine patches in a safe place that’s out of sight and reach of children.

Risks when used with benzodiazepines or other central nervous system (CNS) depressants

Taking buprenorphine with certain substances can cause dangerous side effects. These substances include drugs called benzodiazepines, central nervous system (CNS) depressants, and alcohol. (CNS depressants can cause CNS depression, which is slowed brain activity.)

Taking these substances with buprenorphine can lead to extreme drowsiness, sedation, respiratory depression, coma, and even death.

Your doctor will only prescribe benzodiazepines or other CNS depressants with buprenorphine if there are no alternative treatments to consider. And they’ll prescribe the lowest possible dosages and monitor you for side effects during treatment. Do not drink alcohol with buprenorphine.

Neonatal opioid withdrawal syndrome

Taking buprenorphine for long periods of time during pregnancy can cause neonatal opioid withdrawal syndrome (NOWS). NOWS causes opioid withdrawal symptoms in the baby after birth. With NOWS, your baby has opioid withdrawal symptoms after birth. This condition can be life threatening if it’s not treated. For more information, see the “Buprenorphine and pregnancy” section below.

Other precautions

Before taking buprenorphine, talk with your doctor about your lifestyle and health history. Precautions to consider are described below.

Lifestyle precautions

Some activities that you may not be able do while taking buprenorphine are listed below.

Driving and operating machinery

Buprenorphine can affect your physical and mental ability to safely drive and operate machines. Don’t drive or operate machinery while you’re taking buprenorphine, unless you’re tolerant to the drug and you’re sure you can safely do so.

If you’re concerned about driving or operating machinery while taking buprenorphine, talk with your doctor.

Exposing buprenorphine patches to heat

While you’re wearing a buprenorphine patch, you shouldn’t sunbathe or take hot baths. (But it’s fine to take short, hot showers.) And don’t use saunas, hot tubs, electric blankets, heated waterbeds, heating pads, or tanning lamps. Doing so can increase absorption of buprenorphine into your body. And this could lead to buprenorphine overdose, and sometimes, even death.

Increased body temperature due to strenuous exercise or fever, for example, can also increase absorption of buprenorphine into your body. And this can increase the risk of the drug’s side effects.

Talk with your doctor about how to safely exercise while you’re wearing a patch. Also, talk with them about what to do if you develop a fever. And be sure to call your doctor right away if your breathing gets slow or shallow, or you become very sleepy or confused. These can be symptoms of buprenorphine overdose.

Health precautions

Before taking buprenorphine, you should also talk with your doctor about your health history. Buprenorphine may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Breathing problems. Buprenorphine can cause respiratory depression (slow, shallow breathing). Buprenorphine injection and patches are contraindicated (must not be used) in people who already have respiratory depression. These forms of the drug are also contraindicated in people with severe asthma in situations where their breathing can’t be monitored or urgently treated. If you have any breathing or lung problems, you may have a higher risk for respiratory depression with buprenorphine. Talk with your doctor about whether buprenorphine is safe for you.
  • Older age or being very weak or frail. If you’re older than 65 years of age, or you’re very weak or frail, you may have a higher risk for side effects with buprenorphine. This is especially true for the side effect respiratory depression. If these factors apply to you, talk with your doctor about whether buprenorphine is right for you. You may need a lower than usual dose of buprenorphine and extra monitoring during treatment.
  • Gastrointestinal problems. Buprenorphine can cause constipation and could worsen certain stomach and bowel problems. Use of this drug can also make it harder for doctors to diagnose these problems. Buprenorphine injection and patches are contraindicated in people with a known or possible blockage in their digestive system. If you have a gastrointestinal problem, talk with your doctor about whether buprenorphine is right for you.
  • Problems urinating. If you have trouble urinating, taking buprenorphine could make your condition worse. (As an example, having an enlarged prostate gland could lead to problems urinating.) If you have problems with urination, talk with your doctor about whether buprenorphine is right for you.
  • Pancreas or gallbladder problems. Buprenorphine can worsen pancreatitis (inflammation in your pancreas) and gallbladder problems. If you have any issues with your pancreas or gallbladder, talk with your doctor about whether buprenorphine is right for you.
  • Liver problems. Buprenorphine is cleared from your body by your liver. If you have liver problems, this can cause buprenorphine to build up in your body. And this can increase your risk for side effects from the drug. Buprenorphine can also cause new or worsening liver problems. If you have any issues with your liver, talk with your doctor about whether buprenorphine is right for you. You may need a lower than usual dosage of buprenorphine and extra monitoring during treatment.
  • Adrenal gland problems, such as Addison’s disease. If your adrenal glands don’t produce enough hormones, you may not be able to take buprenorphine. This is because buprenorphine could make this problem worse, which can be dangerous. If you have any problems with your adrenal glands, talk with your doctor about whether buprenorphine is right for you.
  • Heart problems. Buprenorphine patches or injection may cause a type of abnormal heart rhythm called QT prolongation. You may have a higher risk for this side effect if you have heart problems such as heart failure or a slow or irregular heartbeat. You may also have a higher risk if you have a personal or family history of QT prolongation. If you have any heart problems, let your doctor know and talk with them about whether buprenorphine patches or injection is right for you. You may need to have an test done to check your heart health before you start taking buprenorphine patches or injection.
  • Low blood pressure. If you have low blood pressure, taking buprenorphine can worsen your condition. Talk with your doctor about whether buprenorphine is right for you.
  • Head injury, brain tumor, or increased pressure in your brain. If you have head injury, a brain tumor, or increased pressure in your brain, taking buprenorphine may increase your risk for complications. Doing so can also make it harder for doctors to monitor your head condition. If you have any of these listed conditions, you may not be able to take buprenorphine. Talk with your doctor about other possible treatments.
  • Seizure disorders. Buprenorphine can increase the risk of seizures. If you have a seizure disorder such as epilepsy, taking buprenorphine can increase the number of seizures you have. Talk with your doctor about whether buprenorphine is right for you.
  • Allergic reaction. If you’ve had an allergic reaction to buprenorphine or any of its ingredients, you shouldn’t take buprenorphine. Ask your doctor what other medications are better options for you.
  • Pregnancy. Using buprenorphine during pregnancy can cause neonatal opioid withdrawal syndrome. For more information about this condition, see the “Buprenorphine and pregnancy” section below.
  • Breastfeeding. Buprenorphine can pass into breast milk and may be harmful to breastfed children. For more information, see the “Buprenorphine and breastfeeding” section below.

Note: For more information about the potential negative effects of buprenorphine, see the “Buprenorphine side effects” section above.

Here are answers to some frequently asked questions about buprenorphine.

Do levels of buprenorphine show up on a drug screen?

They may not. Many drug screens (also called urine drug tests) look for opioids, which is the type of drug that buprenorphine is. However, drug screens typically look for opioids with high rates of misuse. (With opioid misuse, an opioid is taken in a way other than how it’s prescribed to be used.)

Examples of opioids that have high rates of misuse include morphine, heroin, and related drugs.

Buprenorphine has a different chemical structure than these opioids have. So it won’t usually show up on a drug screen that looks for opioids. Buprenorphine typically only shows up on lab tests that specifically look for buprenorphine.

Doctors, sports officials, and employers may sometimes request a urine drug screen for buprenorphine. So, be sure to talk with your doctor if you’re concerned about buprenorphine showing up on a drug screen.

What’s induction treatment with buprenorphine?

Induction treatment is the first phase of treatment for opioid use disorder (OUD). And buprenorphine is approved for use as an induction treatment for OUD.

With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)

During induction treatment for OUD, you stop taking other opioids and start taking buprenorphine instead. Buprenorphine helps to manage withdrawal symptoms and cravings you may have after stopping other opioids.

Specifically, buprenorphine tablets are used for induction treatment. (The drug patches and injection aren’t approved for this use.)

During induction treatment for OUD, you’ll typically take buprenorphine tablets in a clinic or at your doctor’s office. This allows your healthcare provider to monitor you after you’ve taken the drug. And it means they can treat any side effects that you may have and adjust your dosage, if needed. Induction treatment usually takes about 1 to 3 days.

After induction treatment, you’ll move on to maintenance treatment of OUD. During this phase, you’ll keep taking the lowest possible dosage of buprenorphine that manages your withdrawal symptoms and opioid cravings. For maintenance treatment, buprenorphine is typically used in combination with naloxone. See the “Buprenorphine use with naloxone” section above to read more about this.

And if you have additional questions about treatment phases for OUD, talk with your doctor.

The Food and Drug Administration (FDA) approves prescription drugs such as buprenorphine to treat certain conditions. Buprenorphine may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.

Buprenorphine is an opioid medication that’s available in three forms:

Below, the approved uses for each of these forms is described.

Buprenorphine for pain (injection and patch forms)

Buprenorphine injection and patches are powerful pain relievers. They’re used for pain management when other pain medications:

  • aren’t suitable, or
  • don’t control pain well enough

The FDA has approved buprenorphine injections to manage severe pain. They’re typically given by healthcare providers for short-term pain relief. For example, a buprenorphine injection may be used for pain that’s caused by surgery.

Buprenorphine extended-release patches are FDA-approved to manage severe pain that needs continuous, long-term treatment with an opioid. They’re typically used to relieve chronic (ongoing) pain that’s caused by long-term conditions, such as cancer. Buprenorphine patches are meant to be used on a regular, daily basis. They’re not meant for use only as needed for pain.

Effectiveness for pain

Buprenorphine is well-accepted as an effective treatment for severe pain. For example, in guidelines from the National Comprehensive Cancer Network, buprenorphine patches are included as a treatment option for pain related to cancer.

Buprenorphine for opioid dependence (tablet form)

The FDA has approved buprenorphine tablets to treat opioid dependence, which is also called opioid use disorder (OUD).

What OUD is

With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)

Examples of opioids that may be misused include:

  • prescription pain relievers, such as:
    • hydrocodone (Vicodin)
  • illegal drugs, such as heroin

With OUD, your body and mind are dependent on opioid drugs. This means you need to take opioids in order to function normally. Stopping opioids can lead to withdrawal symptoms, such as sweating, shaking, muscle aches, and diarrhea. It can also lead to opioid cravings and attempts to get access to opioids.

What buprenorphine does for OUD

Buprenorphine helps manage withdrawal symptoms you may have when you stop taking other opioids. While this drug doesn’t produce the same “high” feeling you may get from other opioids, it does reduce cravings for opioids.

Buprenorphine tablets are typically given during the induction phase of OUD treatment. During this phase, you take buprenorphine to help reduce withdrawal symptoms and cravings that you have when you first stop taking other opioids.

Then after the induction phase of OUD treatment, a person may take buprenorphine for the maintenance phase. This phase is the long-term management of opioid dependence. In the maintenance phase, buprenorphine is typically used with naloxone. For more details about this, see the “Buprenorphine use with naloxone” section above.

Buprenorphine can make it easier to stop misusing opioids. But, it must be used as part of a complete treatment program for OUD. This program will usually include counseling or psychotherapy. It may also involve support with social issues, such as housing or employment, if needed. Over time, the aim of the OUD treatment program will be to gradually have you stop taking buprenorphine.

Effectiveness for opioid dependence

Buprenorphine is an effective treatment for opioid dependence. It’s included as a treatment option for opioid use disorder in guidelines from the American Society of Addiction Medicine.

Buprenorphine and children

Buprenorphine injection is approved to manage severe pain in children ages 2 years and older. For more information about this, see the “Buprenorphine for pain (injection and patch forms)” section above.

However, buprenorphine patches and buprenorphine tablets are not approved for use in children.

For long-term management of opioid use disorder (OUD), buprenorphine is typically given with a drug called naloxone. This is called the maintenance phase of OUD treatment.

With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)

For maintenance treatment of OUD, combination medications that contain both buprenorphine and naloxone are typically used. For more details about this combination of therapy, see the “Buprenorphine use with naloxone” section above.

As with all medications, the cost of buprenorphine can vary. To find current prices for buprenorphine tablets (or other forms) in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for buprenorphine, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for buprenorphine, contact your insurance company.

Financial and insurance assistance

Financial assistance to help you pay for buprenorphine may be available.

Medicine Assistance Tool and NeedyMeds are two websites offering resources that may help decrease the price you pay for buprenorphine. They also offer tools to help you find low-cost healthcare, as well as educational resources. To learn more, visit their sites.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to buprenorphine, talk with your doctor. They can tell you about other medications that may work well for you.

Alternatives for pain

Examples of other drugs that may be used to treat pain include:

  • opioids other than generic buprenorphine, such as:
    • buprenorphine (Buprenex, Butrans, Belbuca)
    • oxycodone (Oxycontin, Oxaydo, Xtampza, and others)
    • oxycodone/acetaminophen (Oxycet, Percocet)
    • hydrocodone
    • morphine (Kadian, Duramorph, MS Contin, and others)
    • fentanyl (Duragesic, Subsys, Lazanda, Fentora, and others)
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
    • diclofenac (Zipsor, Zorvolex, Voltaren, others)
    • celecoxib (Celebrex)

Alternatives for opioid dependence

Examples of other drugs that may be used to treat opioid dependence include:

Using more than the recommended dosage of buprenorphine can lead to serious side effects, and doing so could possibly cause death. Do not use more buprenorphine than your doctor recommends.

Overdose symptoms

Symptoms of overdose can include:

  • extreme sleepiness or sedation
  • respiratory depression (slow, shallow, weak breathing)
  • blurred vision
  • slurred speech
  • confusion
  • problems with coordination
  • slowed reflexes
  • dizziness or fainting
  • pinpoint pupils (abnormally small pupils, which allow light into your eye)
  • coma

What to do in case of overdose

If you think you’ve taken too much buprenorphine, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

Use of Narcan for overdose

Buprenorphine overdose can be treated with a drug called naloxone (Narcan). This medication is a nasal spray that can temporarily reverse the effects of an opioid overdose.

Caregivers or loved ones should give Narcan to a person who has known or possible opioid overdose. Continue to administer it until emergency medical help arrives. But, using Narcan isn’t a substitute for emergency medical care. You should call your local emergency number or 911 right away.

You can buy Narcan without a prescription from pharmacies. If you take buprenorphine, your doctor may recommend that you have a supply of Narcan available to you in case of opioid overdose. Talk with your doctor or pharmacist for more information about this.

Buprenorphine is an opioid medication. The injectable form and patch form are used to relieve severe pain. The tablet form is used to help manage opioid use disorder (OUD), which is described below.

How buprenorphine works for pain

Buprenorphine relieves pain by working in your brain to reduce your perception of pain.

The drug does this by binding to attachment sites in your brain called opioid receptors. When buprenorphine attaches to these receptors, it stops your brain from receiving pain signals from other parts of your body.

So, although the cause of your pain may still be present, you’re less likely to feel it or be bothered by it.

How buprenorphine works for opioid use disorder

With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)

For OUD, a person takes buprenorphine to replace other opioids that had been misused.

Buprenorphine is a particular type of opioid called a partial opioid agonist. It attaches to the same opioid receptors (attachment sites) in your brain that other opioids do. But it doesn’t stimulate the receptors as much as other opioids do.

By attaching to opioid receptors, buprenorphine helps control withdrawal symptoms that you may have when you stop taking other opioids. Examples of withdrawal symptoms include sweating, shaking, muscle aches, and diarrhea.

Buprenorphine doesn’t produce the same “high” feeling that you may get from other opioids, even if you take it in high doses. But it has enough of an effect in your body to reduce the cravings you may have when you stop taking other opioids.

Buprenorphine has a high affinity for opioid receptors, meaning it tightly attaches to them. As a result, buprenorphine can block other opioids from attaching to these receptors. So, if you take other opioids along with buprenorphine, they’re less likely to have the desired effect.

Taking buprenorphine can make it easier to stop using other opioids. But, buprenorphine must be used as part of a complete treatment program for OUD. For more information about this, see the “Buprenorphine uses” section above.

How long does it take to work?

How long it takes for buprenorphine to work depends on which form of the drug you’re taking. For example:

  • Buprenorphine injection works quickly to relieve pain. It starts working within a few minutes of receiving the injection into your vein. But it may take about 15 minutes to start working when it’s injected into your muscle.
  • Buprenorphine patches take a while to relieve pain because the drug is absorbed slowly into your bloodstream through your skin. When you first start using a buprenorphine patch, it may take up to 24 hours before you have pain relief. And it may take up to 3 days for the patch to have its full effect. Talk with your doctor if you still have pain after wearing a buprenorphine patch for 3 days.
  • Buprenorphine tablets start working to relieve opioid withdrawal symptoms and opioid cravings soon after you take the tablet. It typically takes about 1 to 2 hours for the tablets to reach their maximum effect.

You should take buprenorphine according to your doctor’s or healthcare provider’s instructions. Below, we describe how each form of buprenorphine is typically administered.

To help make sure that you don’t miss a dose of buprenorphine, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Buprenorphine injection

Buprenorphine injections will be given by a healthcare provider. You may receive these injections as either an:

When buprenorphine injections are given

Your healthcare provider will give the buprenorphine injections as needed to control your pain.

Adults and children ages 12 years and older may receive one dose followed by a second dose 30 to 60 minutes later, if needed.

Some people may require repeated injections of the drug to control their pain. Injections are typically given once every 6 to 8 hours.

Buprenorphine patches

You should apply buprenorphine patches to a dry, hairless, healthy area of skin that’s not irritated. You can apply them on one of the following sites:

  • upper outer arm
  • upper chest
  • upper back
  • side of your chest

If you need to use two patches for your prescribed dose, you can apply them side by side at the same site.

You should wear buprenorphine patches for 7 days and then remove them. After removing a patch, don’t apply another patch to the same site for 21 days. You should use a different site on your body each time you apply a new patch.

Your doctor will explain how to use buprenorphine patches. You’ll also find detailed instructions for using buprenorphine patches in the drug’s medication guide. This instruction is also available in the drug’s prescribing information.

When buprenorphine patches are used

To provide continuous pain relief, you should apply buprenorphine patches once every 7 days. Make a note of the date and time that you apply each patch. Then, plan to change the patch at the same time 7 days later.

Buprenorphine tablets

You take buprenorphine tablets by placing a tablet under your tongue and letting it dissolve there. This typically takes a few minutes. Do not swallow buprenorphine tablets whole.

If you need to take more than one tablet for your dose, you can place them under your tongue at the same time. But if you can’t comfortably keep them all under your tongue at once, you can take them one or two at a time.

When buprenorphine tablets are taken

You should take buprenorphine tablets once a day, at around the same time each day.

These tablets are used for opioid use disorder (OUD),* which has the following two phases of treatment.

  • Induction treatment. This is the starting phase of OUD treatment. During this phase, you’ll typically take buprenorphine doses at a clinic or doctor’s office. You’ll take your first dose when you start to have withdrawal symptoms after stopping other opioids. Typically, you shouldn’t take your first dose of buprenorphine until at least 4 hours after you last took a short-acting opioid, such as heroin. And you shouldn’t take your first dose of buprenorphine until at least 24 hours after you last took a long-acting opioid, such as methadone. Your doctor will explain when you should take your first dose.
  • For maintenance treatment. This is the long-term management of OUD. During this phase, you may be able to take buprenorphine doses at home. For maintenance treatment, buprenorphine is typically used with naloxone. For more information about this combination of therapy, see the “Buprenorphine use with naloxone” section above.

* With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.). For more information about OUD and how buprenorphine is used to manage it, see the “Buprenorphine uses” section above.

Taking buprenorphine tablets with food

You shouldn’t eat or drink while you have buprenorphine tablets under your tongue. Instead, wait to eat or drink anything until after the tablets have fully dissolved.

Can buprenorphine tablets be crushed, split, or chewed?

No, you should not crush, split, chew, or swallow buprenorphine tablets. Doing so will make them less effective for you. Always allow these tablets to dissolve whole under your tongue.

It’s not known if buprenorphine is safe to use during pregnancy.

Limited information from some studies suggests that taking buprenorphine during pregnancy doesn’t increase the risk of developmental problems in a pregnancy. Studies in animals found that buprenorphine caused fetal harm when it was given to pregnant females. But keep in mind that animal studies don’t always predict what will happen in people.

Taking buprenorphine for long periods of time during pregnancy can cause neonatal opioid withdrawal syndrome (NOWS).* NOWS causes opioid withdrawal symptoms in the baby after birth. And this condition can be life threatening if it’s not treated.

Symptoms of NOWS can include:

  • high-pitched crying
  • crying for long periods
  • irritability (getting easily upset)
  • trouble sleeping
  • shaking
  • vomiting
  • diarrhea
  • lack of weight gain

Additionally, if you take buprenorphine during labor or delivery, the baby may be born with respiratory depression (slow, shallow, weak breathing). This condition can also be life threatening if it’s not treated.

If you’re pregnant or planning a pregnancy, talk with your doctor before taking buprenorphine.

They can help you decide on the best treatment plan for your needs, both during and after your pregnancy.

* Buprenorphine injection and patches have a boxed warning from the FDA regarding the risk of NOWS. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Buprenorphine and fertility

Long-term use of opioids, such as buprenorphine, may cause infertility in males and females.* (With infertility, you may not be able to become pregnant or get someone pregnant.)

It’s not known if this effect is temporary or permanent. If you want to have children in the future, talk with your doctor before using buprenorphine.

* Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

It’s not known if buprenorphine is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using buprenorphine.

For more information about taking buprenorphine during pregnancy, see the “Buprenorphine and pregnancy” section above.

Buprenorphine passes into breast milk in small amounts. However, it’s generally thought to be safe to take this drug while breastfeeding.

Talk with your doctor about the best way to feed a child while you’re taking buprenorphine.

If you decide to breastfeed, be sure to monitor the child closely. And tell your doctor if they are sleepier than usual, have trouble feeding, or aren’t gaining weight, as these can be serious side effects of the drug. Call 911 if you can’t wake the child up, they have slow or shallow breathing, or become limp.

It’s possible to become dependent on buprenorphine. And this can happen whether you take it for pain or opioid use disorder (OUD).

With OUD, opioids are chronically misused, which means they’re taken in a way other than how they’re prescribed to be used. (With chronic misuse, misuse happens over and over.)OUD can include opioid dependence and addiction. (With dependence, your body needs a drug in order for you to feel normal. And with addiction, a drug is taken, even if it’s causing harmful outcomes.)

You’re more likely to develop buprenorphine dependency if you take it for long periods of time, or if you misuse it. As a result of dependence, you can have withdrawal symptoms if you suddenly stop taking the drug.

For buprenorphine, withdrawal symptoms can include:

  • restlessness
  • watery eyes
  • runny nose
  • sweating
  • shaking
  • muscle aches
  • diarrhea
  • cravings for buprenorphine and attempts to obtain the drug

Note: Buprenorphine injection and patches have a boxed warning for misuse and addiction. A boxed warning is the strongest warning the Food and Drug Administration (FDA) requires. It alerts doctors and patients about drug effects that may be dangerous. For more information about buprenorphine’s boxed warnings, see the “Buprenorphine side effects” section above.

What can be done

Before prescribing buprenorphine for pain management, your doctor will assess your risk for OUD.

Dependency is possible with buprenorphine when you take it for OUD. However, it’s typically easier to stop taking buprenorphine than it is to stop taking other opioids. For more information about using buprenorphine for OUD, see the “Buprenorphine uses” section above.

If you and your doctor decide that you should stop taking buprenorphine, your doctor will gradually reduce your dosage of the drug. Slowing tapering off of buprenorphine can help you avoid having withdrawal symptoms.

When you get buprenorphine tablets or patches from the pharmacy, the pharmacist will add an expiration date to the label on the packet. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

You should store buprenorphine tablets and patches at room temperature (68°F to 77°F or 20°C to 25°C). You should keep them in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

Keep in mind that buprenorphine has a potential for misuse. (With misuse, a drug is taken in a way other than how it’s prescribed to be used.) So, it’s important to keep it stored in a safe place. Ideally, it should be kept where children cannot see or reach it, and where it is not at risk of theft.

Disposal

If you no longer need to take buprenorphine and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.