BuTrans for Pain Management in USA

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celticgreenman
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medic008 brought this to my attention in another thread, but I thought that more Pharmer members may be interested.

There is a website for more prescribing information at http://BuTrans.com

I spoke with a pharmacist at Purdue Pharmaceuticals.  BuTrans (CIII) (a transdermal buprenorphine)  is authorized for use in pain management in the United States and DOES NOT require the special "X-"  DEA number.  It is not to be used for opioid dependence. 

BuTrans is the only preparation of buprenorphine allowed for use in the treatment of pain.  All others (Suboxone, Subutex, generic buprenorphine, etc) still can only be used for the treatment of opioid dependence and still require the "X-"  number.

cgm

 

 

tunafizzle
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Yeah I've been wondering

Yeah I've been wondering about that since it FDA's orangebook:

http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=021306&TABLE1=OB_Rx

I didn't see many reports of U.S. prescribing until this year though.

Funny how I mentioned in a previous thread how a buprenorphine was already made in transdermal form over a decade ago. I really think buprenorphine should have been available over a decade ago for pain management, and that it hasn't been says something dark about the pharmacuetical lobby. It pains me to see Purdue have the first patent on buprenorphine without prescribing limitations(for pain treatment), now they will be hailed as discoverers of a "new miracle painkiller" with a brilliant R&D department......pshhhhhhhhh
Considering every old opiate has been made into ER form it was only a matter of time until someone put out buprenorphine with restrictions, if Purdue didn't have this in their pipeline they would have had nothing left after 2013 when oxycontin expires.

Saturated
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Anyone have any experience

Anyone have any experience using this medication???

nhm
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I am curious, is this like

I am curious, is this like fentanyl, where it is VERY strong, and only used when one is EXTREMELY tolerant and other opiates must have been tried? Or could it work for someone like me,  who's only prescribed 4 lortab 10/325s a day? Can anything be used for breakthru? Or would it still have the same tight binding to the receptors, preventing breakthru meds like lortab from being effective? This is intriguing, if it really worked well, no pills for a week? Sounds good to me. Anyone used this? I know, too many questions, but inquiring minds want to know.

Melinda

goat
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,,,
Broomhead
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First Hand Experience...

Looking around, it seems that few have had this prescribed. My PM prescribed it for be because I had Gastric Bypass last December. After GB, you can no longer take whole pills or capsules, everything must be liquid or crushed. Prior to GB, I was taking Opana XR with Oxycodone 4x for BT pain. Post-surgery, i was given generic Opana (hydromorphone) 3x per day plus Oxycodone 4x, prescribed by my PM's NP. In April, my PM decided he didn't like me taking two instant release meds and prescribed me BuTrans with Oxycodone 4x for BT. Started on the 5mcg patch, the only benefit I noticed was that I didn't withdraw from the hydromorphone. May, bumped up to the 10mcg patch with a max of six 15mg doses of oxycodone for BT. Still, no benefit. June was another bump to one 5mcg and one 10mcg patch, equalling 15mcg total, plus the six oxycodone. Started feeling a bit of relief, but far off in the periphery. Went back in July, told Dr that I didn't think that 15mcg was enough yet. He said that he'd like me to stay where I'm at to see if things balance out after my weight loss (I had lost 150lbs at that point). I acquiesced and said no problem. July comes, they ask how things are, I said about the same as last time, BuTrans still doesn't feel like its quite there yet. Another month on 15mcg, 6 oxycodone, and bumped Flexeril up to 4 per day. No problem, the Butrans at least helps make the 'edge' a little more dull. August, tell Dr everything's the same, still not there yet with BuTrans, oxycodone are doing ok, Flexeril does nothing. Frustrating as it was, he wanted at least one more month without a change in dose. Again, I acquiesce.

That's where I am now. As to the effectiveness of the patches, they are what they are, just another delivery method. But the buprenorphine is better than the fentanyl, which gave me massive mood swings and a very short, very bad temper. My DR and I don't know yet if the BuTrans patches are like the fentanyl patches in that the fentanyl always ran out 24hrs early. I change my patches every Thursday and started noticing on Tuesday night/Wednesday that I was feeling like &*&?. He suggested that I either overlap the patches by a few hours, or try to keep them on my arms and/or thighs to try and keep my body temp from increasing the med release. The Butrans can be a pain due to the increase in dosage/absorption with external heat, especially in the hot, hot summer. I only had it happen to me once, 99* and 80% humidity, out watching my daughter's softball games. I wasn't sitting in the sun, but it was just plain hot. I started feeling a sickly euphoria and new that I needed to cool the patch off. I grabbed one of those instant ice packs that I had started carrying just for such a situation. I got cooled off and started feeling better. The adhesive on the patch is better than anything I have ever used. I'm not allergic to tape, tape is allergic to me. Nothing haqs ever stuck on my skin, something about my skin and the ph and such. However, these patches have lasted throughout the week, when I'm drenched in sweat, numerous swimming excersions, showers, even accidently lathering them up with soap. They stick so well that after all of that, they still hurt a bit when you pull them off. Another note, you will get some really odd tan lines. I had one that was a perfect rectangle, almost a perfect reduced-size playing card that was white as a babies bottom. I was tempted to draw a card inside it to make it look like a tattoo, but I didn't.

In the 5"x7"x1"ish box, that you get when you fill the script, there will be 4 plastic/foil wrapped patches (a one month supply), similar to wet nap packets, a plastic package of 'disposal units', and a patient/drug info sheet. The 'disposal units' are like big stickers that fold in half like a greeting card, just peel offf half of the wax paper, place the used patch in the highlighted area, remove the rest of the wax paper, fold the sticker in half and press it together starting in the center and working outward. Then, just toss it. No need to flush it, hide it, worry about it, etc. I would recommend that when you get your first script, get with the Pharmacist and open the box with him/her so you can both see what's inside. Last week, I had a Pharmacist, usually the best pharmacist I've ever had, fill my script and mistakenly gave me just the disposal patches. I called him right when I saw the mistake, about 15mins had elapsed, and told him what was going on. He apologized sincerely saying he had never saw what was in a box. Someone had filled a script of the patches for another customer by opening the box, removing the patches, and putting the rest back on their shelf. He noted the mistake in my file and left 2-3 notes for the other Pharmacists. I told him I wasn't mad, but that I just wanted to make sure that I wouldn't have any issues when they were delivered the next day.

jstbelieve
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Yes I Have

Hi,

 I have been useing 2 10mc every 7 days as the 20mc patch does not stick well. I can't afford to throw one away, and I bought every tape you can imagin. $$$$ wise, Pain wise, and Doctors are really not concerned once they give you your monthly prescription, Oh well make it work. That has been my experience, not saying all Doctors are like that but it is really hard if something goes wrong. 1st they are very expensive, and they do not last 7days at all, I know I am the one who suffers until my next patch is ready to be put on. I was going to ask my doctor if he can prescribe these every 5 days, but he gets really nasty at times. They do work very well, I have had no side effects and it takes my pain away and allows me to live a some what normal life! Also I called medicare and they are going to help cover these patches for a year. They would be costing me almost 300$ I pay 81$ for 8 patches so I am very greatful. Also my doctor told me I would go into major instant withdraw if I was to take another narcotic for break thru pain, not sure if thats true but I don't take pills just to take them. I do have breakthru pain, So I take tramodol and (mobic which is an antinflamatory). Think about the pro's and con's. I would like to know if someone really does go thru instant withdraw? Just my own curiousity.

celticgreenman
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Instant withdrawal?

jstbelieve,

No, you do not go into instant withdrawal symptoms if you take another opioid for breakthrough pain with the buprenorphine. The other opioid will most likely just not work very well.

You are already taking an opioid with the buprenorphine. Tramadol is a centrally acting opioid pain medication. So, if the statement had been correct, you would have gone into withdrawal from the tramadol.

.
Buprenorphine is a partial opioid agonist, with a very high affinity for the mu opioid receptor. Thus, when there is an open receptor, it will be filled with the buprenorphine faster than with any other opioid in the system and it holds on tighter to the receptor. But, since it is a partial opioid agonist, it produces less of the medicine's opioid effects, while attached to the receptor.

That is why, when you switch from a full opioid agonist (i.e. oxycodone), to a partial opioid agonist (i.e. buprenorphine), you have to allow the full agonist to clear your system before taking the partial, or you may develop significant withdrawal symptoms. Thus, it is recommended that the patient be in moderate withdrawal before taking his/her first buprenorphine dose.

This is what your physician may have been trying to explain.

.
So, you can take full opioid agonists with the buprenorphine, for breakthrough pain, but since they have less of an affinity for the mu receptors than buprenorphine, their effects will be lessened, as a significant amount of the dose will just be metabolized and filtered out of the system before it can be used by the body. It is essentially a waste of the other medicine.

Hope that helps to explain the withdrawal question.

cgm

nhm
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CGM

Say it was time to change the patch, and you had just taken your oxycodone break thru medication. Would the oxycodone, followed by the new patch, cause the precipitated withdrawal like suboxone?

Melinda

medic008
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No it would not cause

No it would not cause precipitated withdrawls. Buprenorphine has a half life of anywhere between 24 and 60 hours depending on your metabolisim. So, the buprenorphine will still be in your system when you take your oxycodone.

celticgreenman
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Withdrawal

Like medic008 said, doing it that way won't cause the precipitated withdrawal. But, the oxycodone may not work very well, with the buprenorphine in the system.

cgm