Drug Database - Butrans Patch
Butrans Patch is a narcotic analgesic used to manage moderate to severe chronic pain in
patients who need continuous, around-the-clock narcotic pain relief for an extended period
of time. It should not be used to treat occasional pain.
Do NOT take more than the recommended dose without checking with your doctor. Taking more
than the recommended dose may increase your risk of irregular heartbeat.
Do not expose the patch to direct sources of heat, such as:
- heating pads
- electric blankets
- heat lamps
- hot tubs
- heated waterbeds
- Avoid sunbathing; long, hot baths; or other sources of heat to the body
The heat may cause more medicine to be released into your skin and could cause serious,
even FATAL, side effects.
Do NOT use Butrans Patch If
- you are allergic to any ingredient in Butrans Patch
- you have very slow or difficult breathing, severe asthma, or severe lung problems
- you have known or suspected bowel blockage (eg, paralytic ileus) or severe or
persistent diarrhea caused by antibiotics
- you have mild or short-term pain or pain that occurs after surgery
- you do not need to take pain medicine on a regular basis
- you are taking sodium oxybate (GHB) or you have taken a monoamine oxidase inhibitor
(MAOI) (eg, furazolidone, phenelzine) within the past 14 days
Contact your doctor or health care provider right away if any of these apply to you.
Before using Butrans Patch
Some medical conditions may interact with Butrans Patch. Tell your doctor or pharmacist
if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription, especially narcotic pain medicines (eg,
oxycodone, morphine), or nonprescription medicine, herbal preparation, or dietary
- if you have allergies to medicines, foods, or other substances
- if you have a history of blood electrolyte problems (eg, low blood potassium levels)
- breathing or lung problems (eg, chronic obstructive pulmonary disease [COPD], asthma,
- obesity; thyroid problems (eg, myxedema, an underactive thyroid)
- curvature of the spine; adrenal gland problems (eg, Addison disease)
- liver problems (eg, hepatitis B or C)
- skin reactions to adhesives
- kidney problems
- pancreas problems
- prostate problems (eg, enlarged prostate gland)
- trouble urinating
- a blockage of your bladder, bowel, stomach, or urethra
- gallbladder problems
- bowel problems (eg, constipation, inflammatory bowel disease)
- stomach problems
- or recent bladder, bowel, or stomach surgery
- if you have a history of heart problems (eg, cor pulmonale, heart failure), heart
rhythm problems (eg, atrial fibrillation, slow heartbeat), a recent heart attack, or if
you or a family member has a history of long QT syndrome
- if you have a history of a recent head injury, growths in the brain (eg, tumor,
lesion), increased pressure in the brain, or muscle problems (eg, myasthenia gravis)
- if you have a fever, low blood pressure, low blood volume, severe drowsiness, or slow
or shallow breathing
- if you have a history of mental or mood problems (eg, depression, hallucinations),
narcotic dependence, are in alcohol withdrawal, or if you or a family member has a history
of alcohol or substance abuse
- if you are taking an antiarrhythmic medicine (eg, quinidine, sotalol, amiodarone)
Some MEDICINES MAY INTERACT with Butrans Patch. Tell your health care provider if you are
taking any other medicines, especially any of the following:
Antiarrhythmics (eg, amiodarone, quinidine, sotalol), azole antifungals (eg, ketoconazole,
voriconazole), HIV protease inhibitors (eg, atazanavir, ritonavir), or phenothiazines (eg,
chlorpromazine) because they may increase the risk of Butrans Patch's side effects
Benzodiazepines (eg, diazepam), cimetidine, narcotic pain medicine (eg, codeine),
phenothiazines (eg, chlorpromazine), skeletal muscle relaxants (eg, cyclobenzaprine), or
sodium oxybate ( GHB) because the risk of severe drowsiness, severe breathing problems,
and seizures may be increased
Carbamazepine, naltrexone, phenobarbital, phenytoin, or rifamycins (eg, rifampin) because
they may decrease Butrans Patch's effectiveness
MAOIs (eg, phenelzine) because the risk of their side effects may be increased by Butrans
Methadone because its effectiveness may be decreased by Butrans Patch
Medicines that may harm the liver (eg, acetaminophen, isoniazid, ketoconazole, certain
medicines for HIV infection, methotrexate) because the risk of liver side effects may be
increased. Ask your doctor if you are unsure if any of your medicines might harm the liver
This may not be a complete list of all interactions that may occur. Ask your health care
provider if Butrans Patch may interact with other medicines that you take. Check with your
health care provider before you start, stop, or change the dose of any medicine.
How to use Butrans Patch
Use Butrans Patch as directed by your doctor. Check the label on the medicine for exact
Butrans Patch comes with an extra patient information sheet called a Medication Guide.
Read it carefully. Read it again each time you get Butrans Patch refilled.
Do not use Butrans Patch if the pouch seal is broken or if the patch is cut, damaged, or
changed in any way.
Keep Butrans Patch in its original package until you are ready to use it. Apply the patch
as soon as you remove it from the sealed pouch.
Butrans Patch is only to be used on intact, clean, dry skin. Do not apply Butrans Patch
to broken, damaged, or inflamed skin.
The application site should be hairless or nearly hairless. If you have no hairless
areas, clip the hair; do NOT shave it. If the application site must be cleaned, clean
the site with clear water only. Do NOT clean the area with soap, alcohol, lotion, oil, or
other cleansers because the risk of Butrans Patch's side effects may be increased. Allow
the skin to dry before you apply the patch.
Apply the patch to the upper outer arm, upper chest, upper back, or the side of your chest
on either side of your body. Do not apply a new patch to the same skin area for at least
21 days. Do not wear more than 1 patch at a time unless your doctor tells you otherwise.
Press the patch firmly in place with the palm of your hand for about 15 seconds. Do not
rub the patch. Make sure the contact is complete, especially around the edges. Wash your
hands after you apply or handle a patch.
If the patch does not stick, you may tape only the edges with first-aid tape or cover the
patch with a special type of clear adhesive film dressing (eg, Bioclusive, Tegaderm). Do
not cover the patch with any other bandage or tape. Ask your doctor or pharmacist about
the kinds of dressings that should be used.
If the patch falls off, do NOT re-apply it. Apply a new patch to a different skin site.
A patch may be worn continuously for 1 week (exactly 7 days) or as directed by your
doctor. After removing the old patch, a new patch may be applied to a different skin site.
After removing the used patch, fold it in half with the sticky sides together. Flush the
used patch down the toilet. You can also use the patch-disposal unit to seal the used
patch. Never throw Butrans Patch away if it is not sealed in the patch-disposal unit.
Discard the patch out of the reach of children and away from pets.
If you forget to change your patch on the day it is due, change the patch as soon as you
remember. Do NOT double your dose to catch up.
Ask your health care provider any questions you may have about how to use Butrans Patch.
If OVERDOSE Is Suspected
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local
poison control center
http://www.aapcc.org/findyour.htm), or emergency room IMMEDIATELY.
Symptoms may include:
- abnormal snoring
- cold and clammy skin
- excessive drowsiness
- irregular heartbeat
- loss of consciousness
- muscle weakness
- severe dizziness
- slow heartbeat
- very slow and shallow breathing
- very small pupils
Important Safety Information
Butrans Patch may cause drowsiness or dizziness. These effects may be worse if you take
it with alcohol or certain medicines. Use Butrans Patch with caution. Do not drive or
perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle
relaxers) while you are using Butrans Patch; it may add to their effects. Ask your
pharmacist if you have questions about which medicines may cause drowsiness.
Butrans Patch may cause dizziness, lightheadedness, or fainting; alcohol, hot weather,
exercise, or fever may increase these effects. To prevent them, sit up or stand slowly,
especially in the morning. Sit or lie down at the first sign of any of these effects.
Do NOT use more than the recommended dose or use for longer than prescribed without
checking with your doctor. Do not change the patch more often than directed by your doctor.
Butrans Patch may cause withdrawal symptoms if you have a physical dependence on narcotic
medicines (eg, morphine) or other opiates (eg, heroin). Talk with your doctor if you are
dependent on narcotic medicines or other opiates.
Do not expose the patch on your skin to direct sources of heat, such as heating pads,
electric blankets, heat or tanning lamps, saunas, hot tubs, or heated waterbeds. Avoid
sunbathing; long, hot baths; or other sources of heat to the body. Tell your doctor if you
develop a fever. The heat may cause more medicine to be released into your skin.
If the patch comes off your skin and accidentally sticks to the skin of another person,
remove the patch from their skin immediately, wash the exposed area of skin with water,
and call your doctor, emergency room, or local poison control center right away.
Butrans Patch may cause constipation. Talk with your doctor about taking a stool softener
or fiber laxative to prevent or treat constipation.
Tell your doctor or dentist that you take Butrans Patch before you receive any medical or
dental care, emergency care, or surgery.
Lab tests, including liver function, may be performed to monitor your progress or to check
for side effects. Be sure to keep all doctor and lab appointments.
Use Butrans Patch with caution in the ELDERLY; they may be more sensitive to its effects,
especially decreased breathing and drowsiness.
Butrans Patch should not be used in CHILDREN younger than 18 years old; safety and
effectiveness in these children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Butrans Patch, discuss
with your doctor the benefits and risks of using Butrans Patch during pregnancy. Butrans
Patch is found in breast milk. Do not breast-feed while taking Butrans Patch.
When used for long periods of time or at high doses, Butrans Patch may not work as well
and may require higher doses to obtain the same effect as when originally taken. This is
known as TOLERANCE. Talk with your doctor if Butrans Patch stops working well. Do not
take more than prescribed.
Some people who use Butrans Patch for a long time may develop a need to continue taking
it. People who take high doses are also at risk. This is known as DEPENDENCE or
Do not suddenly stop taking Butrans Patch. If you do, you may experience WITHDRAWAL
- back, muscle, or joint pain
- enlarged pupils
- runny nose
- goose bumps and abnormal skin sensations
- increased tearing
- muscle or stomach cramps
- persistent loss of appetite
- rapid heartbeat or breathing
- severe or persistent headache
- trouble sleeping
- and yawning
Get emergency medical help if you have any of these signs of an allergic reaction:
- difficulty breathing
- swelling of your face
Seek medical attention right away if any of these SEVERE side effects occur:
- abnormal sighing or snoring
- burning, swelling, oozing, or blisters at the application site
- chest pain
- dark urine
- difficult, shallow, or slow breathing
- difficulty talking, thinking, or walking
- fast, slow, or irregular heartbeat
- joint or muscle pain
- loss of consciousness
- mental or mood changes (eg, anxiety, depression)
- pale stools
- severe drowsiness, dizziness, or lightheadedness
- severe or persistent headache or stomach pain
- shortness of breath
- swelling of the hands, ankles, or feet
- unusual weakness
- vision changes
- yellowing of the eyes or skin
Check with your doctor if any of these most COMMON side effects persist or become
- dry mouth
- itching, rash, or redness at the application site
Side effects other than those listed here may also occur. Talk to your doctor
about any side effect that seems unusual or that is especially bothersome.