All About Buprenorphine

What is buprenorphine?

If you have certain conditions, your doctor may recommend treatment with buprenorphine. It’s a prescription drug that comes in three different forms.

Depending on the form of buprenorphine prescribed, it may be used for the following:

• Opioid dependence. Opioids are strong pain medications. With dependence, your body needs a drug for you to feel normal. Buprenorphine is used to manage cravings and withdrawal symptoms in adults with opioid dependence who’ve stopped taking opioids. It’s given as part of a complete treatment program along with counseling and suggestions for lifestyle changes.
• Pain. Buprenorphine may be used to treat moderate to severe pain in adults and some children. In this case, the drug is only used for pain that requires treatment with an opioid. And it’s prescribed only if other pain treatments haven’t worked.

For more information on how buprenorphine is used, see the “What is buprenorphine used for?” section below.

Buprenorphine basics

Buprenorphine comes in the following three forms:

• extended-release transdermal patch (a patch that’s applied to your skin), which contains buprenorphine. These patches are used for moderate to severe pain.
• injection, which contains buprenorphine hydrochloride (HCI). It’s given by healthcare providers for moderate to severe pain.
• sublingual tablets (pills that dissolve under your tongue), which contain buprenorphine HCl. These tablets are used to treat opioid dependence.

Buprenorphine is a generic drug. It’s available as brand-name transdermal patches, sublingual tablets, injections, and buccal films. (Buccal films dissolve between your gums and cheek.) Not all of these forms come as the generic medication, though. For example, buprenorphine buccal film is only available as the brand-name drug Belbuca.

Additionally, some forms of buprenorphine are only used in animals, not in people. For instance, buprenorphine sustained-release (SR) is made for veterinary use only.

Read on to learn more about buprenorphine uses, its side effects, and other important information about the drug.

Buprenorphine brand-name versions

Common brand-name versions of buprenorphine include:

• Belbuca (buprenorphine hydrochloride), which comes as buccal films
• Butrans (buprenorphine), which comes as extended-release transdermal patches
• Buprenex (buprenorphine hydrochloride), which comes as an injection
• Sublocade (buprenorphine), which comes as an extended-release injection

Buprenorphine is also available in combination with the drug naloxone in both brand-name and generic versions. For more information about this drug combination, see the “Is buprenorphine used with naloxone?” section below.

Buprenorphine is a generic drug, which means it’s an exact copy of the active drug in a brand-name medication. Brand-name versions of buprenorphine include Belbuca, Butrans, Buprenex, and Sublocade.

Generic drugs are thought to be as safe and effective as the brand-name drug they’re based on. In general, generics usually cost less than brand-name drugs.

Generic drugs may have different fillers and inactive ingredients compared with their brand-name drugs. But these fillers and inactive ingredients don’t affect how the drug works. In rare cases, you can have an allergic reaction to one of these fillers and inactive ingredients. To learn more, ask your pharmacist about your generic medication.

If you’d like to know more about generic versus brand-name drugs, talk with your doctor. And, read this article for more information about generic and brand-name drugs.

Is buprenorphine used with naloxone?

Buprenorphine is available in combination with the drug naloxone. And these combination products come in both brand-name and generic versions.

Examples of medications that contain both buprenorphine and naloxone include:

• Suboxone. Suboxone comes as a film that’s placed either under your tongue or between your cheek and gums to dissolve. The generic version of Suboxone comes as both a tablet that dissolves under your tongue and a film that dissolves under your tongue.
• Zubsolv. Zubsolv comes as a tablet that’s placed under your tongue to dissolve.

Suboxone and Zubsolv contain buprenorphine, but they aren’t the same as buprenorphine.

For instance, buprenorphine can be used for pain and opioid dependence. Opioids are strong pain medications. With dependence, your body needs a drug for you to feel normal.

But drugs that contain both buprenorphine and naloxone, such as Suboxone and Zubsolv, are used to treat opioid dependence. They’re not used for pain.

Buprenorphine is an opioid. Naloxone, on the other hand, is an opioid antagonist. This means it blocks the effects of opioids. In buprenorphine products that contain naloxone, naloxone helps to lower the risk of misuse of buprenorphine. With misuse, a drug is taken in a way other than how it’s prescribed.

If you’d like to know more about taking naloxone with buprenorphine, talk with your doctor.

What are buprenorphine’s side effects?

Like most drugs, buprenorphine may cause mild or serious side effects. The lists below describe some of the more common side effects that buprenorphine may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

• your age
• other health conditions you have
• other medications you may be taking

Your doctor or pharmacist can tell you more about the potential side effects of buprenorphine. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that buprenorphine can cause. To learn about other mild side effects, talk with your doctor or pharmacist. Or, you can view the medication guide for buprenorphine skin patches or the prescribing information for buprenorphine injection or tablets.

Mild side effects of buprenorphine that have been reported include:

• rash, itching, and skin irritation (for buprenorphine injection and skin patches)
• numbness in your mouth (for buprenorphine tablets)
• constipation
• headache
• drowsiness
• dizziness
• sweating
• itching
• nausea and vomiting

Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from buprenorphine can occur, but they aren’t common. If you have serious side effects from buprenorphine, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of buprenorphine that have been reported and are described below in “Side effect focus” include:

• boxed warnings:
  • misuse and addiction of buprenorphine
  • respiratory depression (slowed, shallow breathing)
  • accidental overdose
  • risks if used with certain other drugs*
  • neonatal opioid withdrawal syndrome*
• problems with your adrenal glands
• low blood pressure
• allergic reaction
• liver problems, such as hepatitis (inflammation in your liver)
• QT prolongation (a type of abnormal heart rhythm), with use of buprenorphine patches or injection
• severe reactions where buprenorphine patches are applied on your skin

* For more information about this side effect, see the “What to consider before taking buprenorphine” section below.

Side effect focus

Learn more about some of the side effects buprenorphine may cause.

Boxed warnings

Some forms of buprenorphine have boxed warnings. Boxed warnings are serious warnings from the Food and Drug Administration (FDA). Boxed warnings for buprenorphine injection and patches are described below.

Misuse and addiction. Buprenorphine can increase your risk of misuse and addiction. With misuse, a drug is taken in a way other than how it’s prescribed. And with addiction, a drug is taken even if it’s causing harmful outcomes. Misuse of buprenorphine can increase the risk of overdose, and in some cases, even death.

Respiratory depression. Buprenorphine can cause serious breathing problems known as respiratory depression. With respiratory depression, you have slowed or shallow breathing. This condition can be life threatening and sometimes even fatal. The risk of respiratory depression with buprenorphine is increased in people with lung conditions. For example, this could include the lung condition chronic obstructive pulmonary disease (COPD).

Accidental overdose. Being accidentally exposed to buprenorphine patches can lead to overdose. This is especially dangerous for children who may be exposed to the drug.

Use with central nervous system (CNS) depressant drugs. Taking buprenorphine with other CNS depressant drugs can cause CNS depression (slowed brain activity). This increases your risk of breathing problems, drowsiness, confusion, coma, and even death. Examples of CNS depressants include benzodiazepines and alcohol.

Neonatal opioid withdrawal syndrome (NOWS). Taking buprenorphine while you’re pregnant may cause your baby to develop NOWS. With NOWS, your baby has opioid withdrawal symptoms after birth.

What might help

Before you start treatment with buprenorphine, your doctor will discuss its risks and benefits with you. This includes the risk of misuse and addiction. Be sure to tell your doctor if you’ve experienced misuse in the past. Also, let them know if any of your family members have been affected by misuse. These factors could increase your risk of misuse or addiction with buprenorphine.

If you have certain lung conditions, such as COPD, buprenorphine may not be safe for you. Tell your doctor about all your health conditions before taking this drug.

It’s important to store buprenorphine tablets and patches securely to avoid accidental exposure, especially in children. Your doctor will discuss how to safely store this medication. They’ll also talk with you about the risks of buprenorphine overdose and whether you or a caregiver needs to have naloxone (Narcan) available. (Naloxone is a medication that reverses opioid overdose if it’s given quickly.)

Let your doctor also know about any other medications you take. Certain medications may be dangerous if they’re taken with buprenorphine. To learn more about and see examples of these medications, see the “What should be considered before taking buprenorphine?” section below.

Additionally, using buprenorphine during pregnancy increases the risk of NOWS for your baby. To learn more about NOWS, see the “What should be considered before taking buprenorphine?” section below.

Your doctor will closely monitor you during buprenorphine treatment, especially when you first start the drug and with any dosage changes. Being closely monitored helps to lower your risk of dangerous side effects with buprenorphine.

Low levels of adrenal hormones

Buprenorphine can lower your levels of adrenal hormones. This condition is called adrenal insufficiency. It may be more likely to happen if you use buprenorphine for longer than 1 month.

Symptoms of low adrenal hormone levels include:

• tiredness
• dizziness
• weakness
• nausea
• vomiting

What might help

Tell your doctor if you have symptoms of low adrenal hormone levels.

If your doctor thinks you may have adrenal insufficiency, they’ll order blood tests to confirm the condition. If you have this problem, your doctor may have you slowly stop taking buprenorphine. And they may give you a steroid medication to help your adrenal glands recover.

Low blood pressure

Buprenorphine can cause low blood pressure. And this condition can cause symptoms such as:

• dizziness
• lightheadedness
• fainting, especially when you stand up from a lying or seated position

What might help

When you start taking buprenorphine, your doctor may have you monitor your blood pressure.

Until you become used to how buprenorphine affects you, stand up slowly after lying down or being seated. And be sure to drink plenty of fluids. Having dehydration (a low fluid level) can also cause low blood pressure.

Talk with your doctor if low blood pressure is a concern for you. In some cases, if your blood pressure is very low, your doctor may need to treat it. Or, they may adjust your dosage of buprenorphine or have you stop treatment with the drug.

If you think you’re having a medical emergency due to low blood pressure, call 911 or your local emergency number. Or, have someone take you to the nearest emergency room.

Allergic reaction

Some people may have an allergic reaction to buprenorphine.

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. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to buprenorphine. But if you think you’re having a medical emergency, call 911 or your local emergency number.

How is buprenorphine taken?

Your doctor will explain how buprenorphine is administered. Be sure to follow your doctor’s instructions when taking this drug. Below are commonly used dosages, but always follow the dosage your doctor prescribes.

Taking buprenorphine

Buprenorphine comes in several forms. These include:

• Extended-release transdermal patches. Buprenorphine transdermal patches are applied to your skin. These are available in several different strengths. Your doctor will recommend the strength of patch that’s right for you. This will depend on whether you’ve taken an opioid in the past.
• Solution for injection. Buprenorphine injections are given by healthcare providers. These can be given as either an injection into your muscle or an injection into your vein that’s given slowly over a period of 2 minutes.
• Sublingual tablets. Sublingual tablets are pills that dissolve under your tongue. These come in strengths of 2 milligrams (mg) and 8 mg.

Before starting buprenorphine, it’s important to stop taking all other opioids. Doing so will help you to avoid an opioid overdose. But be sure to discuss this with your doctor. Don’t start or stop taking any medications without first checking with your doctor.

Dosage

The dosage and form of buprenorphine that your doctor prescribes for you depends on:

• the reason you’re taking buprenorphine
• any other medications you’re taking
• any other health conditions you may have, such as liver or lung problems

Below are typical dosages for buprenorphine’s uses.

Dosage for opioid dependence

Buprenorphine sublingual tablets are used for opioid dependence. Opioids are strong pain medications. With dependence, your body needs a drug for you to feel normal.

There are two phases to treatment for opioid dependence. The beginning phase is called the induction phase. And the ongoing phase is called the maintenance phase.

How often you’ll take buprenorphine depends on which phase of treatment you’re currently in and what type of opioids you’d been taking before your treatment.

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

The suggested dosage range of buprenorphine tablets for maintenance phase treatment varies. Your doctor will prescribe the dosage that’s right for you.

Dosage for pain

Buprenorphine injection and patches are used for pain treatment.

Dosage of buprenorphine patches

For buprenorphine patches, the recommended starting dosage depends on whether you’ve already been taking other opioid pain relievers. Your doctor may gradually increase the strength of buprenorphine patch you use until the dose that’s right for you is reached.

This is the dosage that controls your pain, but causes minimum side effects. But, dosage changes shouldn’t be made until you’ve worn a buprenorphine patch for at least 72 hours.

Each buprenorphine patch is usually worn for 7 days.

Dosage of buprenorphine injection

Buprenorphine injections will be given by your healthcare provider as needed to control pain.

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

Your doctor will decide how often to give injectable buprenorphine doses based on your level of pain.

Taking buprenorphine with other drugs

For opioid dependence, buprenorphine is given as part of a complete treatment plan. This treatment plan includes other therapies to help support your recovery goals. These therapies may include:

• counseling
• cognitive behavioral therapy
• support group programs

For pain management, your doctor may also prescribe other treatments with buprenorphine. These may include physical therapy and behavioral therapy.

You may also consider these tips to help relieve chronic (long-lasting) pain.

Questions about taking buprenorphine

Below, we answer some questions related to taking doses of buprenorphine.

• What if I miss a dose of buprenorphine? Buprenorphine injections are given by healthcare providers, so you’re not likely to miss a dose. But, for a missed dose of:
  • buprenorphine tablets, take the missed dose as soon as you remember. But don’t take the missed dose if it’s too close to your next regularly scheduled dose. Taking your doses at the scheduled times will help ensure you don’t have opioid withdrawal symptoms.
  • buprenorphine patches, which should be changed once a week, apply a new patch as soon as you remember. But if it’s too close to when your patch is due to be changed, just skip the missed dose. And follow your regular schedule. Don’t use more than one patch at a time, as doing so could lead to overdose.
• Will I need to use buprenorphine long term? There’s no exact timeframe for buprenorphine treatment. How long you’ll take buprenorphine varies depending on the reason you’re taking it. In general:
  • for pain management, you’ll likely take buprenorphine for only as long as it’s needed. Your doctor will closely monitor you to help you avoid serious side effects, such as overdose.
  • for opioid dependence, your doctor will start you on the lowest dose when you begin treatment. After this, your doctor will likely switch you to another type of medication that also contains naloxone. (Naloxone helps to lower your risk of overdose with buprenorphine.) Buprenorphine is typically used for just a short time during the beginning phase of opioid dependence treatment. Your doctor will explain your treatment plan and how long you’ll need to take buprenorphine.
• Can buprenorphine tablets be chewed, crushed, or split? No, you shouldn’t crush, chew, or split buprenorphine tablets. Doing so can change how they work. It can also increase your risk for serious side effects. It’s important to take buprenorphine tablets (and other forms) exactly as your doctor has prescribed them. This will help you reach your treatment goals and avoid serious side effects.
• Should I take buprenorphine with food? That varies depending on the form of the drug you’re taking. For instance:
  • with buprenorphine tablets, you shouldn’t eat or drink anything with the tablet in your mouth. You’ll place buprenorphine tablets under your tongue, and you should wait until they completely dissolve before eating or drinking anything. This will allow the drug to work properly.
  • for buprenorphine injection and patches, you don’t need to worry about food or drink intake around your doses.
• How long does buprenorphine take to work? How long it takes for buprenorphine to start working depends on the form of the drug you’re taking. For example:
  • Buprenorphine tablets start working to curb opioid withdrawal symptoms within 1 hour after you take a dose.
  • Buprenorphine patches work slowly over time to manage pain. And they continue to work for 7 days. It may take up to 3 days for a patch to have its full effect, especially when you first start treatment or when the dose of your patch is changed.
  • Buprenorphine injections start to work for pain within 15 minutes of being injected into your muscle. And the effect from this type of injection lasts up to 6 hours or more. Buprenorphine injections into your vein will start to work even faster, but their effect wears off sooner.

Questions for your doctor

You may have questions about buprenorphine and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

• Before your appointment, write down questions like:
  • How will buprenorphine affect my body, mood, or lifestyle?
• Bring someone with you to your appointment if doing so will help you feel more comfortable.
• If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare providers are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.

What should be considered before taking buprenorphine?

Before starting buprenorphine treatment, let your doctor know if you:

• are pregnant or planning to become pregnant
• are breastfeeding
• have any health conditions
• are taking any other medications

These and other considerations are described below.

Interactions

Taking medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions. Interactions can also increase the risk of serious side effects.

Be sure to tell your doctor about all the medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with buprenorphine.

Interactions with drugs or supplements

Buprenorphine can interact with several types of drugs. These drugs include:

• Benzodiazepines and other CNS depressants. Taking buprenorphine with benzodiazepines or other central nervous system (CNS) depressants can increase your risk for serious side effects. CNS depressants are drugs that cause CNS depression, which is slowed brain activity. Severe side effects can include respiratory depression (slowed, shallow breathing), coma, or even death. Some examples of these types of drugs include:
  • lorazepam (Ativan)
  • diazepam (Valium)
  • zolpidem (Ambien)
  • muscle relaxants, such as tizanidine (Zanaflex)
• Certain antibiotics and antifungals. A group of antibiotics called macrolide antibiotics (such as clarithromycin) and antifungals (such as ketoconazole) can increase buprenorphine levels in your body. And this increases the risk of side effects with buprenorphine. Your doctor will reduce your buprenorphine dosage if you need to take these types of drugs with it.
• Serotonergic drugs. Buprenorphine interacts with some types of serotonergic drugs, which are drugs that increase levels of a brain chemical called serotonin. These types of drugs may lead to a serious condition called serotonin syndrome. This condition causes high blood pressure, confusion, muscle spasms, nausea, hallucinations, tremors, and seizures. If you take any of these medications with buprenorphine, your doctor will monitor you closely to help you avoid serotonin syndrome. Examples of these drugs include:
  • selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta)
  • tricyclic antidepressants (TCAs), such as amitriptyline
  • triptans, such as sumatriptan (Imitrex)
• Other opioid drugs. Taking buprenorphine with other opioids can increase your risk for serious side effects, including opioid overdose, and even death.

This list does not contain all types of drugs that may interact with buprenorphine. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of buprenorphine.

Other interactions

Buprenorphine also interacts with some supplements and herbs that increase sleepiness or dizziness. This interaction can be dangerous and sometimes severe.

Examples of supplements or herbs that interact with buprenorphine include:

• kava
• valerian root
• melatonin
• cannabidiol (CBD)
• St. John’s wort

Boxed warnings

Some forms of buprenorphine have boxed warnings. Boxed warnings are serious warnings from the Food and Drug Administration (FDA). These warnings for buprenorphine injection and patches are described below.

Misuse and addiction. Buprenorphine can increase your risk of misuse and addiction. With misuse, a drug is taken in a way other than how it’s prescribed. And with addiction, a drug is taken even if it’s causing harmful outcomes. Misuse of buprenorphine can increase the risk of overdose, and in some cases, even death.

Respiratory depression. Buprenorphine can cause serious breathing problems known as respiratory depression. With respiratory depression, you have slowed or shallow breathing. This condition can be life threatening, and sometimes even fatal. The risk of respiratory depression with buprenorphine is increased in people with lung conditions. For example, this could include the lung condition chronic obstructive pulmonary disease.

Accidental overdose. Being accidentally exposed to buprenorphine patches can lead to overdose. This is especially dangerous for children who may be exposed to the drug.

Use with central nervous system (CNS) depressant drugs. Taking buprenorphine with other CNS depressant drugs can cause CNS depression (slowed brain activity). And this increases your risk of breathing problems, drowsiness, confusion, coma, and even death. Examples of CNS depressants include benzodiazepines and alcohol.

Neonatal opioid withdrawal syndrome (NOWS). Taking buprenorphine while you’re pregnant may cause your baby to develop NOWS. With NOWS, your baby has opioid withdrawal symptoms after birth.

For more information about these warnings, see the “What are buprenorphine’s side effects?” section above. And to learn more about NOWS, see the “Pregnancy and breastfeeding” section below.

Other warnings

Buprenorphine may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take buprenorphine. Factors to consider include those in the list below.

• Liver problems. Buprenorphine may not be safe for you if you have liver disease or serious liver problems. This is because buprenorphine can increase your level of liver enzymes (types of proteins). In people with moderate to severe liver disease, this can cause more serious side effects from buprenorphine. Talk with your doctor about any liver problems you’ve had, including hepatitis (inflammation in your liver). Your doctor will check your liver function with certain lab tests before you start taking buprenorphine. They’ll also monitor your liver function while you’re taking buprenorphine. If your liver function worsens, your doctor will have you stop taking this drug and monitor your liver.
• Brain tumors or head injury. Buprenorphine may increase the pressure inside your head, which could cause permanent brain damage. If you have a brain tumor or a history of head injuries, buprenorphine may not be safe for you. Talk with your doctor about brain injuries or increased pressure in your brain. Your doctor will let you know if you should take buprenorphine.
• Lung problems. If you have serious lung conditions or breathing problems, buprenorphine may increase your risk of serious breathing difficulties. Examples of lung conditions include chronic obstructive pulmonary disease (COPD) and asthma. Additionally, this drug can cause respiratory depression (slowed, shallow breathing). Before starting buprenorphine, talk with your doctor about any lung-related problems you have. Your doctor can recommend if it’s safe for you to take this drug.
• Heart conditions. If you have certain heart problems, treatment with buprenorphine can increase your risk for some heart-related side effects. Examples of these heart problems include atrial fibrillation, bradycardia (slow heart rate), and congestive heart failure. Tell your doctor about any heart problems you have and let them know if you’re taking any heart medications.
• Allergic reaction. If you’ve had an allergic reaction to buprenorphine or any of its ingredients, you shouldn’t take buprenorphine. Ask your doctor about other medications that may be better options for you.
• Gastrointestinal conditions. If you have problems with your intestines, such as a blockage called paralytic ileus, buprenorphine may worsen the condition. Ask your doctor if you can take buprenorphine if you have this condition. And be sure to tell your doctor about any problems you have with your gastrointestinal system.
• Problems urinating. If you have trouble urinating, taking buprenorphine could make your condition worse. For example, having an enlarged prostate gland could lead to problems with urination. If you have problems with urination, talk with your doctor about whether buprenorphine is right for you.
• 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 worsen this problem, which can be dangerous. If you have any problems with your adrenal glands, talk with your doctor. They can tell you whether buprenorphine is right for you.

Use with alcohol

You should avoid drinking alcohol while taking buprenorphine. Drinking alcohol while taking buprenorphine can cause serious side effects, including:

• respiratory depression (slowed, shallow breathing)
• confusion
• dizziness
• sleepiness
• slow heart rate
• coma
• in some cases, death

Ask your doctor for more information about the risks of drinking alcohol while you’re taking buprenorphine. And if you’re concerned about avoiding alcohol during buprenorphine treatment, let your doctor know.

Pregnancy and breastfeeding

Talk with your doctor before taking buprenorphine during pregnancy or while you’re breastfeeding.

Use during pregnancy

Taking buprenorphine during pregnancy may cause your baby to develop dependence on the drug. This condition is called neonatal opioid withdrawal syndrome (NOWS). (Keep in mind that buprenorphine is an opioid.)

With NOWS, your baby has opioid withdrawal symptoms after birth. They may receive treatment for NOWS in the hospital. Some symptoms of NOWS include:

• unusual crying or irritability
• diarrhea
• vomiting
• tremors
• irregular sleeping patterns
• lack of weight gain

Buprenorphine patches and injections have a boxed warning about the risk of NOWS. For more information about boxed warnings, see the “What are buprenorphine’s side effects?” section above.

If you’re pregnant or planning to become pregnant, talk with your doctor about the risks and benefits of buprenorphine treatment.

Use while breastfeeding

Buprenorphine may pass into breast milk. Certain forms of buprenorphine aren’t recommended for use while breastfeeding. This is because the drug can increase the risk of serious breathing problems, drowsiness, and sleepiness in a child who’s breastfed.

Symptoms of respiratory depression, which is a serious breathing problem that may occur in breastfed children, include:

• trouble breathing
• blue lips or mouth
• excessive sleepiness

Ask your doctor if it’s safe to breastfeed your child while you’re taking buprenorphine.

What are some frequently asked questions about buprenorphine?

Find the answers to some commonly asked questions about buprenorphine below.

Will a drug screen show that I’m taking buprenorphine?

Yes, buprenorphine may show on some drug screens. But this depends on:

• the type of drug screen
• when the drug screen is performed
• the form of buprenorphine that’s being taken (injection, patch, or tablet)

For instance, a 12-panel urine drug screen can detect buprenorphine. (A 12-panel drug screen looks for 12 types of drugs in your urine.) But other drug screens may not detect buprenorphine.

Depending on the form taken, buprenorphine may show in drug screens for up to 7 to 10 days after it was last taken. Using extended-release patches of buprenorphine can cause the drug to remain in your body even longer and show up on drug screens.

If have more questions about buprenorphine and drug screens, talk with your doctor. And be sure to let your doctor know you’re taking buprenorphine before having a drug screen.

What’s meant by ‘induction treatment’ with buprenorphine?

When buprenorphine is used for opioid dependence, the beginning phase of treatment is called the induction phase. Opioids are strong pain medications. With dependence, your body needs a drug for you to feel normal.

During the induction phase, your doctor will carefully manage your dosage of buprenorphine. This helps to ensure that you don’t have opioid withdrawal symptoms and cravings, helping you have success with treatment.

How long the induction phase lasts depends on your treatment progress. But in general, the induction phase typically lasts for a few days. Your doctor will monitor you and they’ll adjust your buprenorphine dosage as needed.

Once you’ve completed the induction phase, you’ll move into the maintenance phase of opioid dependence treatment. Talk with your doctor for more information about the maintenance phase and what your recommended treatment plan is.

How does buprenorphine work?

Buprenorphine is an opioid that’s also a partial opioid agonist.

It binds to certain receptors (attachment sites) in your brain called mu opioid receptors. These receptors are responsible for sending pain signals in your body. By binding to these receptors, buprenorphine blocks pain signals from being sent to the rest of your body.

Buprenorphine has strong affinity (attraction) to mu opioid receptors. That’s why it works to both control pain and manage opioid cravings and withdrawal symptoms.

For more information about these uses of buprenorphine, see the “What is buprenorphine used for?” section below.

For pain management, buprenorphine has a dose-limiting effect. This means higher doses of buprenorphine don’t provide greater pain relief. (Full opioid agonists, such as morphine, don’t have this dose-limiting effect.)

To manage opioid cravings and withdrawal symptoms, buprenorphine competes with other full agonist opioids. Examples of these include codeine and morphine. Buprenorphine knocks these opioids off their receptors by strongly binding to the receptors itself. This helps to manage withdrawal symptoms and opioid-related cravings.

Buprenorphine doesn’t cause the “high” effects that are related to using some other opioids. It causes less dependence and has a lower risk for misuse compared with full agonist opioids. With dependence, your body needs a drug in order for you to feel normal. And with misuse, a drug is taken in a way other than how it’s prescribed.

What is buprenorphine used for?

If you have certain conditions, your doctor may recommend treatment with buprenorphine. It’s a prescription drug that comes in three different forms. And depending on the form of buprenorphine prescribed, it may be used to treat opioid dependence or manage moderate to severe pain.

These uses are described in more detail below.

Buprenorphine for pain (injection and patches)

Buprenorphine injection and patches may be used to treat moderate to severe pain. For this use, buprenorphine injection can be given to adults and children ages 12 years and older. But buprenorphine patches can only be given to adults.

In this case, buprenorphine is only used for pain that requires treatment with an opioid (strong pain medications). And it’s prescribed only if other pain treatments haven’t worked.

Buprenorphine injections are used for short-term pain relief. Typically, they’re given for pain management after a surgery or other medical procedure. Buprenorphine patches, on the other hand, are used for long-term pain relief. They’re typically given to manage pain that’s caused by long-lasting conditions, such as cancer.

Buprenorphine works by binding to certain receptors (attachment sites) in your brain. These receptors are responsible for sending pain signals in your body. By binding to these receptors, buprenorphine blocks pain signals from being sent to the rest of your body.

Buprenorphine is a type of opioid called a partial opioid agonist. For pain management, it works differently from full agonist opioids. (Examples of full agonist opioids include morphine and codeine.) This is because buprenorphine has a limit (ceiling) on its effects. Higher doses of this drug don’t provide greater pain relief. And higher doses may lead to increased side effects of the drug.

Buprenorphine for opioid dependence (tablets)

Buprenorphine tablets are used to treat opioid dependence in adults. Opioids are strong pain medications. With dependence, your body needs a drug for you to feel normal. Dependence on opioids may lead to opioid use disorder (OUD).

Specifically, buprenorphine is used for the beginning phase of treatment for opioid dependence. It’s used to manage cravings and withdrawal symptoms in people with opioid dependence who’ve stopped taking opioids. It’s given as part of a complete treatment program along with counseling and suggested lifestyle changes.

If you suddenly stop taking opioids when your body is dependent on them, you can have strong cravings for opioids. You can also have withdrawal symptoms from opioids. Possible opioid withdrawal symptoms include:

• body aches
• anxiety
• irritability
• poor sleep
• sweating

Buprenorphine helps you function better without having withdrawal symptoms and cravings when you stop taking other opioids. Buprenorphine is an opioid, too. But it knocks other opioids off their attachment sites in your body by strongly binding to the attachment sites itself.

Buprenorphine doesn’t cause the “high” effects that are related to using some other opioids. It causes less dependence and has a lower risk for misuse compared with other types of opioids. With misuse, a drug is taken in a way other than how it’s prescribed.

After you’ve completed the beginning phase of OUD treatment, your doctor will most likely switch you to a medication that contains both buprenorphine and naloxone. For more information about the phases of OUD treatment, see the “How is buprenorphine is taken?” section above.

What does buprenorphine cost?

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for buprenorphine tablets (or other forms) in your area, visit GoodRx.com.

Financial assistance to help you pay for buprenorphine may be available. Medicine Assistance Tool and NeedyMeds are two websites that provide resources to help reduce the cost of buprenorphine.

These websites also offer tools to help you find low-cost healthcare and certain educational resources. To learn more, visit their websites.

What should be done in case of overdose?

Don’t take more buprenorphine than your doctor prescribes. Using more than your prescribed dose can lead to serious side effects, including overdose.

It’s important to note that buprenorphine overdose could cause you to stop breathing. So, if you don’t get treatment right away to reverse the overdose, your risk of death is increased.

Symptoms of overdose

Symptoms of buprenorphine overdose can include:

• drowsiness or sleepiness
• trouble breathing
• very low blood pressure
• small pupils (center part of your eye that lets light in)
• loss of consciousness
• changes in your heart rate
• coma
• in some cases, death

What to do in case you take too much buprenorphine

Opioid overdose is serious and can be life threatening. (Keep in mind that buprenorphine is an opioid.) Getting immediate treatment for overdose can possibly save your life.

Ifyou have symptoms of overdose, call 911 or your local emergency number right away. Or, have someone drive you to the nearest emergency room.

Use of naloxone for buprenorphine overdose

Before prescribing buprenorphine tablets or patches, your doctor may recommend that you have naloxone (Narcan) available. Naloxone is a drug that reverses opioid overdose. It’s given by caregivers or loved ones to someone with a known or possible opioid overdose.

With certain forms of buprenorphine (such as patches), standard doses of naloxone may not work to reverse overdose. This is because the buprenorphine contained in patches is long-acting.

It’s important to get medical help right away for buprenorphine overdose. Using naloxone isn’t a substitute for emergency medical care. Even if naloxone is given, 911 or your local emergency number should be called right away.

Can buprenorphine be misused?

Some forms of buprenorphine have boxed warnings for misuse and addiction. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

Specifically, buprenorphine injection and patches have a boxed warning for misuse and addiction. With misuse, a drug is taken in a way other than how it’s prescribed. And with addiction, a drug is taken even if it’s causing harmful outcomes.

Misuse of buprenorphine can increase the risk of overdose, and in some cases, even death.

Be sure to take buprenorphine exactly as your doctor has prescribed it for you. Don’t change your doses on your own.

If you’re taking buprenorphine for pain and your pain isn’t well-managed, call your doctor. They can evaluate you and adjust your treatment plan for better pain relief.

If you’re taking buprenorphine for opioid dependence and you’re having opioid withdrawal symptoms or cravings, call your doctor. They can help you stay on track with your treatment plan and suggest ways to manage your symptoms.

To learn more about how buprenorphine is used for pain and opioid dependence, see the “What is buprenorphine used for?” section above. To read about all of buprenorphine’s boxed warnings, see the “What are buprenorphine’s side effects?” section above.

What to ask your doctor

If you have certain conditions, your doctor may recommend buprenorphine. It’s used for moderate to severe pain that’s not controlled by other treatments and opioid dependence.

To learn more about these uses, see the “What is buprenorphine used for?” section above.

Your doctor will prescribe the form of buprenorphine that’s right for you, depending on the reason you’re taking this drug. To learn more about the available forms of buprenorphine, see the “How is buprenorphine taken?” section above.

If you’re taking buprenorphine for pain management, ask your doctor what you can expect with buprenorphine treatment. Possible questions you may have include:

• Are patches or injections of buprenorphine right for me?
• Which form of buprenorphine has more side effects?
• Will I have withdrawal symptoms if I stop using buprenorphine patches?

If you’re taking buprenorphine for opioid dependence, consider asking your doctor:

• What over-the-counter pain medications are safe to take with buprenorphine?
• Do I need to carry naloxone with me for possible opioid overdose?
• What should I expect when I first start buprenorphine treatment?

Also, read these articles to learn more about the basics of pain relief, natural treatment options for pain, and management of chronic (long-lasting) pain. To learn more about treatments for opioid dependence, check out this article.