Palliative Care : Buprenorphine Patches

What is a Buprenorphine patch?

Buprenorphine is a strong painkiller medication used to control moderate to severe pain that has not been controlled by weaker pain medicines.  A Buprenorphine patch is a sticky patch containing buprenorphine, and when applied to your body gradually passes through your skin into your blood stream evenly over several days to relieve pain.

There are many myths about strong painkillers. These can often cause fears and worries and may lead to pain not being well controlled. It can help to know some of the facts about these medicines. Our leaflet does not replace conversations with your doctor, nurse or pharmacist, but reading it may help you decide what questions you may want to ask.

Why have I been prescribed Buprenorphine patch?

Buprenorphine is most useful in patients with “stable” pain that does not require many changes in medication doses. It is also prescribed for patients who have difficulty swallowing tablets or cannot tolerate other strong painkillers.

How is Buprenorphine taken?

Buprenorphine patches are available in a variety of strengths, most commonly used are 5, 10, 15 And 20 microgram/hour. Most commonly used in palliative care are 7 day patches, however there are patches available which are changed every 3-4 days.

Always check the name and the dose on your medication packet prior to application. It I important that you are clear how often the patch needs changed, particularly if the dose or brand changes. On occasions you may need to wear more than one patch to make up the correct dose for you. Seek advice from your healthcare professional or pharmacist if you are unsure or require clarification.

What should I do if I still get pain whilst I have a Buprenorphine patch on?

Buprenorphine patches provide a continuous dose of pain relief.  However you may develop pain despite this, which may be referred to as ‘breakthrough pain’.

In addition to the patch you will be given a quick or short acting medication in tablet or liquid form (morphine or oxycodone) for you to take for the ‘breakthrough pain’.  These medication start to work in around 20-30minutes and lasts approximately 4 hours.  There are different strengths tailored to your needs and can be adjusted as needed.

Reasons why you might get pain include

When you first use Buprenorphine patches, or if your dose is increased, it can take a day or more for you to feel maximum benefit.  You may experience pain while doing a particular activity despite the patch e.g. washing or walking.  If you know an activity is likely to cause you pain, you can take a dose of your quick acting pain relief before you do the activity. Sometimes you may experience pain without an obvious cause.

How do I use a Buprenorphine patch?

Apply to dry non inflamed, irritated, clean, hairless skin to upper trunk or arm, avoiding areas with large scars. The patch should be pressed firmly in place for at least 30 seconds, wash your hands to remove any residue.  Where more than one patch is required, they may be applied to the same area of the body, as long as the edges do not touch.

Change your patch as directed (either every 7, 3 or 4 days) at roughly the same time of day e.g. for 7 day patch, if applied to the skin on Monday at 10am it should be replaced with a new patch on Monday at 10am. All patches should be changed at the same time. Change the area where you apply the patch so that one area is not used twice in a row (check individual instructions supplied with Patches as this advice may vary depending on brand).

You might like to use this table to write the current brand and strength of patch

What side effects should I look out for?

• Constipation - These medicines can cause constipation in most people.  Eating more fruit, vegetables, brown bread, bran based cereals and drinking more fluid may help but most people will still need a regular laxative.
• Feeling sick or vomiting - This can happen when you first take these medicines but it usually only lasts for a few days.  Your doctor can give you some anti-sickness medicine for a few days until this settles.
• Drowsiness – if you become unusually sleepy after starting on Buprenorphine patches, or after the dose has been changed, contact your GP/Palliative Care Nurse/District Nurse.
• Skin rashes/irritation – some people have an allergic reaction to the adhesive on the patch, and may develop itching or redness under the patch, please contact your health professional who prescribed the patch.
• A high body temperature - may increase the absorption of the drug from the patch. If there is an increase in any of the above side effects contact your GP/Palliative care nurse/district nurse. Similarly, you should not apply a heat pad to the body near to the patch.

Storage and disposal

Your Buprenorphine patch needs to be kept in a safe place out of reach of children and pets.  Patches should be disposed of carefully by folding them in half to stick firmly together and if possible replacing them in their packet. The packet can then be placed in the household rubbish.  Please return any unused patches to the pharmacy

Frequently asked questions

What do I do if I forget to change my patch?

Put a new patch on as soon as you can. If there has been a long delay you may need to take extra doses of your quick release pain medication, whilst waiting for the level of Buprenorphine in your body to increase.

What can I do if my patch falls off frequently?

It is advised to check your patch regularly to ensure it remains firmly attached. If the patch does not stick securely try clipping hairy skin (do not shave) and avoid using soaps, oils, creams or ointments. If problems persist contact your GP/District Nurse for advice.

Can I go for a swim or take a shower?

Yes. Patches are waterproof, however, having a hot bath wearing a patch is not recommended.

Can I take my medication on holiday?

Please consult your GP as you may require a letter. If you have any queries, please do not hesitate to contact your doctor, nurse or pharmacist.

Will I become addicted to Buprenorphine?

No. Taking Buprenorphine for pain will not make you become an addict. If another treatment can relieve the pain we can often reduce or stop Buprenorphine but this should be done in a controlled way. You should not stop using the patch without discussion with your doctor or nurse.

Can I drink alcohol?

Yes although be cautious and stick to small amounts of alcohol, ideally wait until you are established on a stable opioid dose.

What about driving?

Please see separate leaflet on driving which has more information.
Remember – ultimately the risk lies with you. It is an offence to drive whilst your ability is impaired, if in doubt, you should not drive. It is suggested that you carry a copy of your prescription or a used medicine packet when driving.

For more information go to www.gov.uk/drug-driving-law

Confidentiality

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For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302