Select a medication above to begin.
buprenorphine
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate associated risks; reserve opioid analgesics for patients with inadequate tx alternatives; proper dosing and titration essential to decr. respiratory depression risk
Addiction, Abuse, and Misuse
Schedule III controlled substance with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Adult Dosing .
Dosage forms: SL TAB: 2 mg, 8 mg; INJ: 300 mcg per mL
Special Note
- [prescribing info]
- Info: strongly consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
opioid use disorder
- [induction tx]
- Dose: 2-4 mg SL x1, may incr. by 2-4 mg SL q1-2h prn up to 8 mg/day on day 1, then give equivalent total daily dose from day 1 on day 2, may incr. by 2-4 mg SL q1-2h prn up to 16 mg/day on day 2, then may incr. by 2-4 mg/day prn until symptoms stabilized; Start: when mild-moderate withdrawal symptoms present and >6h after last short-acting opioid use or >24h after last long-acting opioid use; Info: do not cut/chew/swallow SL tab
- [maintenance tx]
- Dose: 4-24 mg SL qd; Start: equivalent total daily dose on last day of induction tx, then may adjust by 2-4 mg/day prn; Info: single-ingredient buprenorphine products not preferred for maintenance tx except in select patients; do not cut/chew/swallow SL tab; doses >24 mg/day rarely more effective; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually over several months to D/C
pain, moderate-severe
- [300 mcg IM/IV q6-8h prn]
- Start: 300 mcg IM/IV x1, may repeat dose x1 after 30-60min, then 300 mcg IM/IV q6-8h prn; Max: 300 mcg/dose IV; 600 mcg/dose IM; Info: use lowest effective dose, shortest effective tx duration; titrate slowly in patients 65 yo and older; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [SL route]
- mild impairment: no adjustment; moderate impairment: not defined, caution advised; severe impairment: consider decr. usual dose by 50%
- [IM/IV route]
- mild-moderate impairment: not defined; severe impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: SL TAB: 2 mg, 8 mg; INJ: 300 mcg per mL
Special Note
- [prescribing info]
- Info: strongly consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, moderate-severe
- [2-12 yo]
- Dose: 2-6 mcg/kg/dose IM/IV q4-8h prn; Max: 6 mcg/kg/dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [13 yo and older]
- Dose: 300 mcg IM/IV q6-8h prn; Start: 300 mcg IM/IV x1, may repeat dose x1 after 30-60min, then 300 mcg IM/IV q6-8h prn; Max: 300 mcg/dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
opioid use disorder (off-label)
- [induction tx, adolescents]
- Dose: 2-4 mg SL x1, may incr. by 2-4 mg SL q1-2h prn up to 8 mg/day on day 1, then give equivalent total daily dose from day 1 on day 2, may incr. by 2-4 mg SL q1-2h prn up to 16 mg/day on day 2, then may incr. by 2-4 mg/day prn until symptoms stabilized; Start: when mild-moderate withdrawal symptoms present and >6h after last short-acting opioid use or >24h after last long-acting opioid use; Info: do not cut/chew/swallow SL tab
- [maintenance tx, adolescents]
- Dose: 4-24 mg SL qd; Start: equivalent total daily dose on last day of induction tx, then may adjust by 2-4 mg/day prn; Info: single-ingredient buprenorphine products not preferred for maintenance tx except in select patients; do not cut/chew/swallow SL tab; doses >24 mg/day rarely more effective; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually over several months to D/C
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [IM/IV route]
- mild-moderate impairment: not defined; severe impairment: not defined, caution advised
- [SL route]
- hepatic impairment: consider adult hepatic dosing for guidance