FYI: Dental warning for oral buprenorphine users

[Dougg]

Greetings, all. I’m in the process of switching over to buprenorphine for my RLS symptoms. In the course of doing so, I came across a disturbing warning from the FDA that use of oral buprenorphine can cause serious dental issues. In essence, the problem is that holding a sublingual tablet in your mouth for the recommended time results in exposure to the teeth of a very acidic liquid. Perhaps this is widely known, but I wanted to raise a flag in case this is new information for some, as it was for me.

The FDA warning is here: fda.gov/drugs/drug-safety-a...

I asked my dentist about this and he replied: “Holding a liquid substance with pH of 3.4 in your mouth continuously for thirty minutes a day everyday [which assumes three tablets a day at 10 minutes per tablet] would cause a devastating amount of dental decay very quickly in some mouths.” The FDA report indicates that the problems can be serious and have occurred even in people who had no history of dental issues.

As a result, I’ve switched to buprenorphine patches and am giving those a try.

[Jelbea]

Thank you Dougg for giving us this information. I am on the patch Butec and I think the leaflet which comes with it warns about dental problems. However, I have been on patches for almost two years and have had no trouble although I am scrupulous in cleaning and flossing just to be on the safe side. I can see that having the temgesic melting in your mouth would put you at much more risk of tooth decay. I had been hoping to change to temgesic but this is making me think again. I am also on oral chemo which can cause mouth problems so have to be extra careful. Do let us know how the patches are working for you and thank you again for the info.

[Joolsg]

I use Buprenorphine sub lingual and it takes about a minute to dissolve. However, it does cause a dryer mouth and I think that can lead to dental issues.

[Amrob]

Thanks for sharing this Dougg.Can i ask how you're getting on with the buprenorphine patches?

How do they compare to the tablet?

[Dougg]

Hi Amrob. The patches are working very well for me, although I do supplement them with a half-tablet of oral buprenorphine sometimes in the evening when my RLS is at its worst, and near the end of the 7-day patch period when the patch is winding down. I’m very careful to rinse my mouth right after any tablets in order to restore a proper mouth pH and hopefully avoid any tooth deterioration. The use of both is specific to my situation, and others might be fine just with patches.

The best thing I like about the patches are (1) I can put it on and forget about it for a whole week, (2) they avoid the potential dental issue that can arise with the tablets, and (3) I have an enlarged prostate, and it’s very clear that, for me, the tablets make that problem worse; it’s harder to pee when I’ve taken the tablets, but I don’t seem to experience that issue with the patches.

[Dougg in reply to Dougg]

I should add that the patches are considerably more expensive for me than the tablets. That may not be an issue for you, depending on whether you have drug insurance. I don't have any, but I was able to get a good discount through GoodRx.com.