Buprenorphine (transdermal)

Buprenorphine (transdermal) is evaluated for the following indications with varying evidence strength: Moderate-to-severe chronic pain (evidence tier B), Chronic fatigue (evidence tier F). See the full indication matrix with dosing and citations above on this page.

Common side effects of Buprenorphine (transdermal) (≥ 1 in 100): Drowsiness, Nausea, vomiting, Constipation, Dizziness, Itching and erythema at patch site, Dry mouth. See the Safety section for uncommon and serious reactions.

FDA category C. Use in pregnancy carries neonatal abstinence syndrome risk when used in T3. For chronic pain in pregnancy, non-opioid measures are first-line; when an opioid is needed, short-term lowest-effective dose is preferred.

Buprenorphine passes into milk in small amounts. Compatible with breastfeeding with monitoring of infant sedation, weight gain, and feeding behavior.

Buprenorphine (transdermal) is contraindicated in: Buprenorphine hypersensitivity; Severe respiratory failure, acute bronchospasm; Severe hepatic impairment; Acute alcohol intoxication, delirium; Opioid dependence requiring full agonists. Full list in the Safety section.

FDA boxed warning: risk of addiction, abuse, severe respiratory depression, and death. Combination with benzodiazepines, alcohol, gabapentin, or pregabalin is hazardous. Prescribe only for clear indications, at minimum effective dose, and with scheduled review.