Butrans patch

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Butrans patch

Post  Platypus on Fri Apr 04, 2014 6:51 pm

Has anyone tried this for their headaches?
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Re: Butrans patch

Post  tortoisegirl on Fri Apr 04, 2014 8:46 pm

Nope. This is one of the few pain medications I haven't tried. Was this recommended for you, or are you researching it on your own? Just curious.

I was pretty close to trying Suboxone though, which has the same main ingredient (Buprenorphine), so I've done some research. However I just had too many concerns, especially as I'd need to switch from Methadone, and have more issues treating my acute pain than my baseline pain. I consulted with a pain doctor my pain doctor referred me to regarding this.

He wanted me to go to a rehab facility to manage the withdrawal needed to start this medication (if someone is already on opiates). There isn't a place in my area set up for chronic pain patients. It really didn't sound like a good fit, as it was structured for an addiction patient.

Plus I had general concerns about the medication, such as not being able to use opiate pain medications for acute pain while on it, and a fear that switching back to Methadone if needed would have difficulties.

I think for someone with chronic pain with little to no opiate tolerance whose pain has got to the point they need an opiate who has very steady pain levels and who isn't currently on an opiate, this would be a very good pain medication choice. If someone has significant opiate tolerance, the dose probably wouldn't be high enough for them.

In that case, the Subutex or Suboxone pills or strips could be tried (these patches are a fraction of the dose of even the smaller Suboxone dose). However, the big difference is that Butrans is approved for chronic pain while Subutex & Suboxone are (currently) only approved for opiate dependency.

Although technically opiate dependency doesn't have to mean addiction (a pain patient on daily opiates is dependent but is rarely addicted for example), I see how having to write that on the prescription to get it covered by insurance could potentially cause issues down the road in seeking pain treatment. It not being FDA approved for chronic pain is another reason I wasn't comfortable with Suboxone.

If someone is currently dependent upon an opiate pain medication, the switch can apparently be quite tricky though. This would be a good first line opiate for some patients as you don't build tolerance to it (which would usually cause the need for dose escalations, something I've had a bit problem with).

I personally don't see much advantage to a patch over pills, but some folks do. Probably as I had a bad experience with the Fentanyl patches. Even discounting them not working for my pain, they weren't sticking in the middle, caused welts/rashes, and were generally annoying. Best wishes.

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Re: Butrans patch

Post  Mule Kick on Sun Apr 06, 2014 3:58 pm

I never have, but after reading this thread I found that http://www.drugs.com/pro/butrans-patch.html has very much Exclamation  (maybe, too much Question ) information. I read it for awhile, then got tired before I had read much of what is available there.


Last edited by Mule Kick on Sun Apr 06, 2014 4:00 pm; edited 1 time in total (Reason for editing : add one word)
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Re: Butrans patch

Post  Platypus on Tue Apr 08, 2014 10:00 pm

I researched Butrans on my own and proposed it to my neuro. I think he's going to prescribe it, he seemed receptive, but is conferring w/ a colleague who is a pain specialist first.

I tried the Fentanyl patch. No physical problems w/ the patch, but it was so sedating I was sleeping night and day. Butrans is appealing because it's supposed to be non-sedating.

My neuro and I discussed Suboxone previously. He couldn't prescribe it, some special license/certificate is necessary as its targeted use is addiction.

The blockade effect is a bit of a worry if I get in an accident or need another opiate for a second condition in the future. If the hospital has Buprenorphine/Suboxone they could give me that I guess? I will find out. My regular HA abortive is DHE so no problem there.

Will it help? Who knows. There are loads of positive reviews, but nobody seems to be using it for HA. I will report.

-Platy
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Re: Butrans patch

Post  tortoisegirl on Wed Apr 09, 2014 7:29 pm

Platy-Thats good your doctor is consulting with a pain doctor. Ideally I'd recommend seeing a pain doctor if you start on this medication (or any long acting narcotic), as they have the most education & experience in that area. I hope you are able to try it and find it helpful.

Yes, an additional amount of any Buprenorphine containing product could be added to try for additional pain relief as needed. However, studies show that there is an ideal amount for pain relief, and going over that isn't likely to add more relief. The doctor I saw said when prescribing Suboxone for pain he has at times had the dose variable, so more could be taken for breakthrough pain.

The patches are pretty low dose compared to the pills though, so there should be room to add more Buprenorphine to increase the pain relief if you did need it. Plus:

-there are some non-narcotic meds that can be helpful in emergency situations (Tramadol is ok to use for example, and the usual stuff like Toradol), or they could just sedate you through the worst of it

-if a high enough dose of opiates was given it should work for pain (and it would likely be much easier to "break through" the Buprenorphine at the low dose of the patches compared to the pills...a max of 20 micrograms an hour for the patches vs. a minimum of 2 milligrams per approximately 8 hours for the pills)

-if the patch was removed, after a period of time the Buprenorphine would begin to leave the system and opiates at reasonable doses could be used

Actually, when prescribing Suboxone or Subutex for pain instead of addiction, the special license is not needed. It will however be much easier for your doctor to prescribe and your insurance to pay for the Butrans patches. Agreed it is less likely to cause sedation. That said, Buprenorphine can have a lot of the same side effects as opiates, such as constipation.

I'll be very interested to see how you do on it. If I wasn't already on a pain medication and needed to start one, it would be my first choice. Keep in mind that it will take a bit of time to get into your system, and your doctor will likely start you on one of the lower doses (5 or 10 mcg/hr), but it can be increase up to 20 mcg/hr after a period of time. Best wishes.

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Re: Butrans patch

Post  carlajo on Sun Apr 13, 2014 5:49 pm

Hi-I haven't posted for a while but I wanted to comment on this Butrans Patch question:

My best friend and I see the same PM Management Doctor. He started her on the Butrans Patch at her first appointment and she has been on it since. At first, it really seemed to help her, she was able to function somewhat "normally" and felt great. (Tho her Fibro pain is worse than her Migraine pain, it still was used for both kinds of pain.) However, as time went on, the effectiveness seemed to level out and she didn't have as great of success as she had in the beginning.

She started out at 10mg and is now on 15mg. She changes her patch every 3-4 days.

So overall, it is somewhat effective, tho it was more effective at first...he doesn't want to switch her to Fentanyl (I have been on Fentanyl patches and they work great for me.) so she is on these for now. They lower her pain level 2-4 points on a daily basis.

I hope this helps!!
Carlajo Smile

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Re: Butrans patch

Post  Platypus on Mon Apr 14, 2014 12:20 am

Well the 5mcg patch isn't doing crap. I've had HA's 3 of the 4 days since I put it on, and it's only supposed to take 18-24 hours to kick in. It was itching like CRAZY, gave me a nasty welt. I took it off, cut off the adhesive edges and reapplied it w/ a Tegaderm cover. That fixed the itching at least.
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Re: Butrans patch

Post  tortoisegirl on Mon Apr 14, 2014 8:03 pm

Platy-Sorry its been tough so far. I had my share of skin issues when I was on the Fentanyl patches. Never could figure out how not to get welts and itching (I had a raised red outline of a patch), and had issues with the middle of the patches becoming unstuck (due to sweat).

For those type of patches thats bad as the medication is in the adhesive matrix. Keep in mind that removing & reapplying the patch may be a similar issue in that it won't fully stick to the skin so the full dose may not be there.

I hope the skin issues clear up for you so you can increase the dose and see if you can get pain relief. So you were able to cut off part of the patch without removing any medication? I'm not familiar with how they are designed. If so, thats good.

I also used Tegaderm covers (and later found a knock off online that comes on a roll which was much cheaper), as I had no extras. So is the medication otherwise tolerable? Keep us posted. Best wishes.

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Re: Butrans patch

Post  Platypus on Mon Apr 14, 2014 10:30 pm

Hi TG, the Butrans patch is different from the Fentanyl style where the medication is "woven" into the adhesive. Butrans uses an older style where there is a reservoir of medicine in the center surrounded by adhesive which just holds the patch on.

Do you remember where you found the Tegaderm knock-offs?

I asked my neuro about increasing the dose but I'm not sure if he will be comfortable.
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Re: Butrans patch

Post  tortoisegirl on Tue Apr 15, 2014 8:47 pm

I hope your doctor will reconsider increasing the dose after a period of time, as even the strongest patch is quite weak on the opiate scale. Thanks for the info on the patch type. What I bought was called OpSite by Smith & Nephew. but there are some other options as well for the material that comes in a roll (some perforated, some not).

There is also some major brand that makes something exactly like Tegaderm, but I forget who. The Tegaderm covers are definitely easier to deal with though.

If you get the stuff on a roll, be sure to measure the patch size and buy a width of material which is wider than the shorter side. Although I've heard of folks using multiple layers of Tegaderm (such as to cover a large patch), I think its a no-no, as would be covering an entire patch with tape (instead of just the edges).

If I was on a patch again, I'd probably go the Tegaderm route out of ease, even though its more expensive, although getting them in bulk on Ebay or whatever helps.

You probably don't want to buy too much of any cover material though in case you end up not getting relief and not being able to go up in dose. Best wishes.

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Re: Butrans patch

Post  Platypus on Sun Apr 20, 2014 1:06 am

My neuro approved an increase to the 10mcg patches so we'll see if that makes a difference...
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Re: Butrans patch

Post  tortoisegirl on Sun Apr 20, 2014 10:59 am

Good luck! Have you had any side effects? How is the skin irritation? Best wishes.

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Re: Butrans patch

Post  Platypus on Thu Apr 24, 2014 8:45 pm

I'm on day 3 at 10mcg. Too early to evaluate really. Since my bad experience w/ the first patch causing itching and welts I've been applying them to my upper arms instead of my side. No more problems w/ itching and welts. Have had no side effects so far, no sedation. I actually did break out of a nasty pattern of every other day, all day bad migraines today. But can't rate a treatment on one good day...
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Butrans Experience

Post  pittiemom on Wed May 07, 2014 7:36 pm

Platy
You may be WAY past this now, but I just joined and saw your post topic. I was on the Butrans patch last year. It helped my pain, but I HATED IT. It made me really tired all of the time. I felt drugged. I can handle demarol & several hyrocodone and feel better than I did on the patch. I was working in an office at the time and literally had a hard time staying awake at my desk. I hope it helps you!

Pittie
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Re: Butrans patch

Post  Platypus on Fri May 09, 2014 4:30 pm

I have sedation from other medicines I take. The Butrans hasn't made it worse. It's been about 2 weeks on the 10mcg patch and my HA's have been somewhat less frequent: about one out of every three days instead of one out of every two days. Could be the patch or could be coincidence, but the pattern change did occur right when I started Butrans.
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Re: Butrans patch

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