If you have been prescribed a 'melt in the mouth' buprenorphine tablet/wafer (for example, Espranor® oral lyophilisate): If your doctor tells you to use more than 1 patch, follow the instructions that come with the patches. Do not let the patches overlap on your skin. Tablets are usually only taken when you need them so you're unlikely to forget. However, if you're unsure what to do, ask your pharmacist or doctor for advice. Anagnostis EA, Sadaka RE, Sailor LA, Moody DE, Dysart KC, Kraft WK (October 2011). "Formulation of buprenorphine for sublingual use in neonates". The Journal of Pediatric Pharmacology and Therapeutics. 16 (4): 281–284. doi: 10.5863/1551-6776-16.4.281. PMC 3385042. PMID 22768012.

For example, Subutex and Suboxone are not standalone opioid addiction treatments. When used alone, their benefits will be minimal. One of the major active metabolites of buprenorphine is norbuprenorphine, which, in contrast to buprenorphine itself, is a full agonist of the MOR, DOR, and ORL-1, and a partial agonist at the KOR. [83] [84] However, relative to buprenorphine, norbuprenorphine has extremely little antinociceptive potency (1/50th that of buprenorphine), but markedly depresses respiration (10-fold more than buprenorphine). [85] This may be explained by very poor brain penetration of norbuprenorphine due to a high affinity of the compound for P-glycoprotein. [85] In contrast to norbuprenorphine, buprenorphine and its glucuronide metabolites are negligibly transported by P-glycoprotein. [85]Your doctor may switch you to morphine tablets or liquid or another similar painkiller so they can reduce the dose even more slowly. How to take or use it

Suboxone EU Approval". Ema.europa.eu. Archived from the original on 24 December 2016 . Retrieved 7 November 2016. Quotas – Conversion Factors for Controlled Substances". Deadiversion.usdoj.gov. Archived from the original on 2 March 2016 . Retrieved 7 November 2016. Too much buprenorphine can be dangerous. However, the amount that can lead to an overdose varies from person to person.Kraft WK, van den Anker JN (October 2012). "Pharmacologic management of the opioid neonatal abstinence syndrome". Pediatric Clinics of North America. 59 (5): 1147–1165. doi: 10.1016/j.pcl.2012.07.006. PMC 4709246. PMID 23036249. If you often forget to change patches, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines. If you take or use too much The most severe side effect associated with buprenorphine is respiratory depression (insufficient breathing). [14] It occurs more often in those who are also taking benzodiazepines or alcohol, or have underlying lung disease. [14] The usual reversal agents for opioids, such as naloxone, may be only partially effective, and additional efforts to support breathing may be required. [14] Respiratory depression may be less than with other opioids, particularly with chronic use. [28] In the setting of acute pain management, though, buprenorphine appears to cause the same rate of respiratory depression as other opioids such as morphine. [46] Central sleep apnea is possible with long-term use, possibly resolving with dose reduction. [44] [45] Buprenorphine dependence [ edit ]

Do not expose your patch to strong heat or sunlight while wearing it, as this can increase the amount of buprenorphine that gets absorbed into your skin and can increase the risk of side effects or overdose. This includes long hot baths, saunas, electric blankets, hot water bottles, heat pads and sunbathing. Yassen A, Kan J, Olofsen E, Suidgeest E, Dahan A, Danhof M (May 2007). "Pharmacokinetic-pharmacodynamic modeling of the respiratory depressant effect of norbuprenorphine in rats". The Journal of Pharmacology and Experimental Therapeutics. 321 (2): 598–607. doi: 10.1124/jpet.106.115972. PMID 17283225. S2CID 11921738.

Buprenorphine helps people to change their thinking, behavior, and environment. Complements education, counseling, and other support measures that focus on the behavioral aspects of opioid addiction. Immediate medical help was needed for people taking Subutex who developed blurred vision, excessive sleepiness, or who became uncoordinated, with slurred speech, slowed reflexes or breathing, or confusion. Buprenorphine maintenance may not work for everyone, so it is important to work with a doctor or drug counsellor to find the best approach. Advantages of buprenorphine maintenance over heroin use Doses are required only once a day, sometimes even less often, because buprenorphine’s effects are long lasting

Jacob JJ, Michaud GM, Tremblay EC (1979). "Mixed agonist-antagonist opiates and physical dependence". British Journal of Clinical Pharmacology. 7 (Suppl 3): 291S–296S. doi: 10.1111/j.1365-2125.1979.tb04703.x. PMC 1429306. PMID 572694. You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.Not every individual is suitable for this type of treatment, whether this is due to personal differences or a previous history of long-term drug abuse and misuse. Side effects may include respiratory depression (decreased breathing), sleepiness, adrenal insufficiency, QT prolongation, low blood pressure, allergic reactions, constipation, and opioid addiction. [14] [18] Among those with a history of seizures, a risk exists of further seizures. [14] Opioid withdrawal following stopping buprenorphine is generally less severe than with other opioids. [14] Whether use during pregnancy is safe is unclear, but use while breastfeeding is probably safe, since the dose the infant receives is 1-2% that of the maternal dose, on a weight basis. [19] [14] Common (1% to 10%): Dizziness/vertigo, nervousness, somnolence, hypoesthesia, tremor, migraine, paresthesia, syncope, hypertonia, dysgeusia, exanthema, sedation In combination with samidorphan or naltrexone (μ-opioid receptor antagonists), buprenorphine is under investigation for the treatment of cocaine dependence, and recently demonstrated effectiveness for this indication in a large-scale (n = 302) clinical trial (at a high buprenorphine dose of 16mg, but not a low dose of 4mg). [109] [110] Neonatal abstinence [ edit ]