Buprenorphine patches v tablets

[Ruffabug]

Hi. I have just been prescribed Butrans (Buprenorphine) weekly skin patches. These are for pain control as I have terminal cancer and getting constant pain. I also suffer from refractory PLMD and am on a high dose of Neupro patch(6mg). I am hoping that the Buprenorphine will mean that I don’t get any more augmentation from the Neupro patch. My main question is : I have read on this site that the weekly patch stops working after five days. Is this correct?. I would prefer to take the sublingual tablet instead but my palliative care doctor says no I must have the patches. I don’t know yet what dose they will be but she says they are a a low dose to start with but they may increase if needed. She knows about my PLMD and says they will help with them. She doesn’t believe that they will stop working after five days. Is there a patch that is for a few days rather than a week?

Thanks for all your support now and in the past. I probably have around 2-3 months left.

[LotteM]

Dear Ruffabug, so sorry to read this. Although your tone seems to suggest that you have accepted you shortterm outlook. I hope it will be a not too bad 2-3 months.

On the patch: start it and see. I found that one brand (in my case Teva) lasts about the full 7d, whereas other brands (have tried Sandoz and now Glenmark) do not.

There are 4 patches in a package. If you find your patches stops working early do put on a new patch while leaving the old one on (it most likely still delivers some buprenorphine) and get it touch with your doctor. Do make notes to support yourself.

In your situation the patch may indeed be preferred as it provides a constant level over 24h and hopefully 7d, and you need that I assume.

Be aware that for the first patch to reach effective level it takes some 12h. See inlay.

Wishing you days with low pain and no RLS and lots of warmth and social support.

Lotte

[Ruffabug in reply to LotteM]

Thank you Lotte for your helpful reply.

[Joolsg]

Dear Ruffabug,I do hope the palliative care team can contol your pain and RLS.

You can ask them to replace the Butrans patch earlier than 5 days if you start to experience pain or increased RLS.

I think palliative care doctors are more likely to take account of what their patients experience.

Wishing you strength and sending virtual hugs.

[Ruffabug in reply to Joolsg]

Thank you Jools for your reply.

[Kakally]

I do find that my Butec patch only lasts 4-5 days. But I am fine if I have a (low dose) 5ug patch on Saturday and put a new one on on Tuesdays. I.e. I always have 2 patches on but they are changed every ~3-4 days . So a twice weekly boost seems to keep my blood levels reasonably constant.

My very best wishes to you🤗

[Ruffabug in reply to Kakally]

Thank you for your reply.

[707twitcher]

The attached graphs show the effectiveness of buprenorphine patches over the course of 7 days (and the bottom chart shows three 7-day cycles layered together). While the patch has a lot of effectiveness still at the 7 day mark, it is only about half of what peak effectiveness is at Days 2-4. So you either wind up with a dose that is high enough to cover you on days 6 & 7 but is more than needed on days 2-4, or what most of us experience - a dose that just covers you through day 5 or 6. If side effects bother you (constipation, hot flashes, insomnia, nausea), you'll want the lowest possible dose, meaning you need to switch patches at the 5 or 6 day mark.

Maybe you can show this to your doctor to help you get the dose right for you after you see how you do with side effects?

ars.els-cdn.com/content/ima...

here is the source of the charts:

sciencedirect.com/science/a...

[Ruffabug in reply to 707twitcher]

Yes I will thanks. I mentioned the problem when the doctor suggested it but she said she had not heard of that.

[Jumpey]

I don't have experience of buprenorphine but just wanted to reach out.I dearly hope you find peace from pain and rls during your final months.And that you're completely comfortable, comforted and surrounded by love.

[Ruffabug in reply to Jumpey]

Thank you for your kind words Jumpey!

[Bowie4eva]

Same as Jumpey. Sending you very, very, very best wishes. X

[Ruffabug in reply to Bowie4eva]

Thank you too!

[davchar23]

Dear Ruffabut,

I am so sorry to hear about your situation and hope that our forum can bring you some respite.

I like several on this site (eg Lotte M and 707twitcher) have carried out a lot of experimentation on buprenorphine patches and below offer my conclusions to date. Firstly let me say that patches offer far more control of RLS than tablets and i have tried both in many forms.

Bupre patches definitely block RLS but none of the brands i have tried last the full 7days (more likely 5/6 days) including Butran. The other problem with bupre is its side effects

I use two times 7.5mch/hour patches (i have to cut a 15mcg/hr in half and no such thing as a 7.5 mcg/hour patch). I use the two patches "staggered by 2 days and this prevents the level of Bupre in my system from rising beyond the nausea level. I apply a new patch the day before the day i remove the old patch. I also sometimes find that the mid week level is not quite enough (ie I need slightly more than a steady 15mcg/hr) and I then take half a bupre sublingual tablet (ie 100mcg) and this gets me through the "week".

God bless and hope this information is useful.

Best regards

Davchar23

[Ruffabug in reply to davchar23]

Thanks for your reply. I don’t know whether I will be given the option to have 7.5 patches and cut them up. I will have to see how it goes.

[Merny5]

I am saddened to read of your situation in this post. I do not have any experience with the Butrans patch but I want to express my sincere hope that your healthcare staff will be able to provide your with comfort 24/7. God bless you Ruffabug❤️

[Ruffabug in reply to Merny5]

Thank you so much for your kind words. I am under an excellent palliative care team at my local hospice.