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Butrans - any tips?

Author treowth - Kent

5 Jan 2011

  Had a reasonable chat with my GP this morning. He understands my reluctance to take opiates but seeing as I am in a bit of a (painful) state at the moment he has suggested I try patches as the release of drug is continual and steady, not the peak/trough of oral opiate based meds.
So he has suggested I try the above. Has anyone got any tips / experiences they would be willing to share. I am a bit nervous.


 StephB - Dorset

5 Jan 2011

 Hi there, I used BuTrans patches for several months last year, and only came off them as I felt I was too woolly to drive on them and have young kids to ferry to school etc. However, I would say they are one of the best pain meds I have ever used, not least because they give a regular dose, including through the night and keep you topped up 24/7 at the same rate.

At first you may feel rather wiped out and drowsy and it takes about 2-3 days for the level to rise appropriately when you first use the meds, but bear with it. Also, you usually start on a 5 patch but you may need 10 if its not working well enough. Your GP will advise on all this.

Finally, lots of us found that the patch didnt last 7 days, it more or less ran out on day 6. Lots of us reported this to Napp who make the product, but they did nothing. Instead, personally I changed the patch on day 6, but you must discuss this with your GP.

If you do a search in the topic bar, you will find lots more on them - type in Butrans.

Good luck with them, hope they work well. If not, the other patch to try would be fentanyl, which works in the same kind of way.

I really miss using them as they gave me much better sleep. Most people are able to drive on them, but for me, even on a 5 I just didnt feel sharp enough. Do wait til you get used to them though before you drive, as I said at first you feel more woolly than you will do once you are used to them.

Hope they work for you, Steph
 bombaypink - uk

25 Jan 2011

 Hi there,

I'm on my second week of BuTrans 10. I have a compressed and bulging disc, therefore really intense nerve pain down my leg and a numb foot.

I am bedridden and awaiting an appointment with a neurosurgeon, and the pain has been mainly unbearable. My GP has been really empathetic and helpful, trying to help me figure out the right cocktail of drugs to bring some level of relief.

The BuTrans is by far the best thing I've tried, and in the last 4 weeks I've tried a lot. It hasn't taken the pain away, but it is reduced by about 70%.

I was losing my mind with the relentless pain, this has made me feel like a person again, not just my pain.

Hope this helps
 kaz01 - Nottinghamshire

25 Jan 2011

 Email : 
 Hi - I have been on Butrans 20's for about 3 months now and I can easily say that I didn't feel any relief till I went up to the 20's but now it has certainly taken the sharpest edge off the pain - probably at best 50% better but it's the 50% that would take the wind out of me if I moved wrong so wouldn't be without them. I am on a rather big list of opiate pain and muscle relaxant meds so I do tend to feel a bit woolly anyway but the butrans don't seem to have made this any worse. Good luck and I hope you get the benefit from them that I do Karen xx
 sarahwithstars - harrow, nw lo

25 Jan 2011

 I have used butrans on and off for three years, it takes the edge off.
Im at 20mcg now and i am reluctant to increase any more because I cant start feeling worse than I do already but with side effects.

it is a good drug, but it doesnt take the pain away, and it doesnt help me forget how bad the day before was, and it doesnt help me be optimistic about the future. that is what Family Guy is for.
 fireworkmaster - Eastbourne Ea

26 Jan 2011

 hiyas butrans when i first started initialy were no help but the dose was to low was on the 10mg ones upped to the 20s and things started to get a little better as many others have said you do not get the peaks and troughs that you do with pills however you will still need to keep stronger meds on hand for breakthrough pain.
i am now on butrans patches bigger brother which is transtec patches the 70s ones of them these are changed every 3 days unlike butrans whch is every 7 and yes they do seem to run out on day 6 so i would definatly talk to doc about changing on 6th day not 7th.
also do not be discouraged if they do not help initialy you may well find you need a higher dosage

this may be of use in working out the strength of the patches they do not sound like much when your say taking solpadol 500/30 as for example they have 30 mg codine in and the 5mg butrans patch is equivilant to 60mg over 24 hours but it is continual i know when my patch starts to run out first thing i notice is my knees start aching and then if i havent changed it withing a few houyrs of noticing that then i know im in for a bad night/day
allways advisable to carry a spare patch in your purse/wallet as sometimes they can fall off something else as well is when doc perscribes them get him to give you some antihistamine cream as well as the patches can sometimes cause severe itching at the site where it is stuck on. Cont....
 fireworkmaster - Eastbourne Ea

26 Jan 2011

  the best med i have come across to help with my pain is the patches without them and my breakthrough meds i would be on floor screaming.
as i said before stick with them as it may take a little while to get the dose you need right and make sure doc takes you up in stages not just straght onto much higer dose do not skip sizes as you will feel rough as hell if he does that
hope this help and good luck

hear is the conversion data

lol sorry dident realise i had written an essay :D post count told me off
 StephB - Dorset

26 Jan 2011

 Thanks so much for posting the conversion chart, really interesting. Always wondered what some of the drugs I am on are equivalent to, so it was really useful and have saved it for future reference. Now I know why oramorph always seems so weak as its half the strength of my usual oxycodone - explains a lot!
 Ruth - Lancashire

26 Jan 2011

 Thanks for sharing the chart. It was very informative & interesting to look at.

I was wondering about the antihistamine cream: do you apply it then rub it off - how would the patches stay on if your skin isn't grease-free?

I've developed rash/spots problem with Versatis patches on my back but am praying I don't with the Butrans. I won't be putting the Butrans on my back though as I've had bad rash with TENS pads on my back in the past. I take a daily antihistamine tablet anyway for issues with allergies & sinus problems but I could substitute that for the cream on alternate days if rash becomes a problem.

 thepaingame - belfast

14 Feb 2011

  im new to pain support so hi. i have very severe pain 24/7 and take different tablets to try to help me. me gp who is lovley put me on the butrans 5 then 10mg patches but they have had very little effect for me. i dont know how to tell him the 10mg isnt having any real impact on the pain and that im still awake all night etc with pain. ive also taken an extra tramadol when i know i shouldnt. i like the idea of the pain relief being more constant with the patches, unlike pills,but not if it doesnt work. could butrans work for me at a higher dose. i like like my gp and want it to work as he tries to help me so much. any advice as to how to tell him would be much appreciated. thank you.
 StephB - Dorset

14 Feb 2011

 Hi, welcome to the site and hope you find us a friendly bunch and lots of useful info on here! 5 or 10 patches are seen by many to be quite low doses, so I would definitely go back to the GP and ask if you can up the dose. He might let you try putting a 5 and a 10 on at once for a week to see if that helps, or if not, moving you up to the 20s. If not, have you tried the fentanyl patches before because maybe that drug would work better for you? Personally, I was quite ill on fentanyl but fine on Butrans, but others have found the opposite. Im sure your GP wouldnt want you to be suffering and not saying - seems pointless having a medication that isnt working on the pain properly.

Hope you get some help soon. Steph
 lyssie - Guildford

16 Feb 2011

 Email : 
 Hiya I am now on BuTrans (but changing to a different patch of the same drug because of skin irritation driving me barmy) and used to be on BuTrans last year also (before being put on Fentanyl) I find the Buprenorphine gives me a decent amount of relief. More so than Fentanyl (everyone is different!) I am just starting off on a low dose as I've only just been put on them but working up the dosage I think.

I haven't got any side effects on this drug I haven't noticed anything but recently I've not been sleeping right so have mouth ulcers. That is all I've noticed so probably isn't to do with the patches.

I hope you find them helpful x
 thepaingame - belfast

22 Feb 2011

 Email : 
 hi steph b,dorset, firstly thank you so much for taking the time to reply i appreciate it very much. what you said made sense and i will tell my gp that the butrans 10mg isnt doing much. i just dont want him to think im trying to be funny with him, if you know what i mean as hes a sweetheart and really wants to help me. he has already told me that he may have to up the dose anyway. so i guess i should stop being a big baby and tell him 10mg isnt working. sorry for being waffly and thanks again for your kind help
jacqui x
 treowth - Kent

4 Apr 2011

 Hello again,

I have increasing pain from my prolapse and my gp has increased me to butrans 20. I always suffer side effects when my meds are increased and i was wondering if anyone had any tips to reduce the side effects?

I know I need the stronger meds - it's just a juggling everything.

All help appreciated!

 StephB - Dorset

4 Apr 2011

 Sadly it seems to be a time thing with meds when you up them or start on new ones and experience side effects. When I was first on BuTrans I spent so much time asleep or muzzy but within a couple of weeks it passed. Hope you get through it soon.
 ari-babes - Northern Ireland

5 Apr 2011

I was put on the Butrans patches, I went from the lowest dose to the highest dose.
One of the problems I found was that one kind of Butrans, you keep on for 4 days, and the other one is left on for 1 week, but I was having to change it every day, as I was sweating under it so much, I had horrific marks on the site.
When I saw my doctor, she explained that due to it being Morphine based, it does make you sweat.
The pain relief was good, but the itching due to the sweating out did the good.
I am now on Lidocaine Patches, you just keep them on for 12 hours, so I wear them thru the night, they're great.
 Mickey 2414 - Sittingbourne

24 May 2011

 Hi i am new to this site & need a bit of help please. I am changing over from Fentanyl 50mg Trandermal patches to Butrans as my doctor feels that i need to change after 6yrs. The patch was only lasting 2 days then i started getting the jitters etc, i was using Remediene pills as a breakthrough painkiller but the pains have steadedly got worse over the last few months. i am on this strong painkilling medicine because of a serious accident i had 9yrs ago. Has anyone else changed over to the weaker patches, i noticed a lot going the other way Butrans to Fentanyl. At the moment i am down to 25mg & a 5mg of Butrans Patch (First stage) & i am having a few jitters & feeling rather ill some of the time, the withdrawal isnt a nice feeling. Because I have been on Fentanyl for over 6yrs i am well addicted to the drug now. I am not looking forward to the next stage going from the 25mg to the 12mg & 10mg Butrans. Can anyone help me with any advice how to cope with the breakthrough without taking too many pills to combat the hot sweats & jitters etc. Thanking you
 mizpah - UK

29 Aug 2012

I have suffered with RSD since 1997. I have taken all sorts of medication. What suits one, may not suit another. But what I would say about any Morphine based medication, "be aware it can, and does stop your bowel muscle from working after long term use".
But you have to take into consideration the quality of life you want.

May Tomorrow Be Better Than Today
 organiclemon - London

29 Aug 2012

 I have found my local drug and alcohol service really helpful on helping with reducing opiate dosing. They are supportive even though I am not the typical client they see I am not an addict but oin these drugs for pain relief. However teh support on reducing doses etc from a drugs worker was excellent and knowledgeable. Things like carbs help ease the jitters a bit and have boiled sweets to help sugar craving (watch sugars oif diabetic). Very individual but your local service is walk-in -anyone can just self refer and ask for help.
Good luck.
 Oakleaf - Shropshire

29 Aug 2012

 Have been using BuTrans for a couple of years, along with other meds and it works well for me.
As with everything in pain management it's all trial and error, a bit of this and a bit of that.
Regarding side effects, initially a little sleepy so I just reduced the dose, again remembering it's all about getting the balance right.
I would definately recommend BuTrans to anyone, 5 m/g to start and just see how it goes.
 picton - West Midlands

30 Aug 2012

 After weeks of instability after moving up from Tramadol with a roller-coaster ride on Palexia,then Fentanyl both with Oxycodone for breakthrough, I was getting a bit fed up that I was not getting on with anything.

So, have moved on to BuTrans, only to find no detectable effect at all on 5mcg/hr patches - and was taking Oxycodone all day and even all night too, and barely getting a wink of sleep as a result. The first 10mcg patch was stuck on yesterday, and today is the first day I have not rushed for the Oxycodone, and was RELATIVELY pain-controlled (I wont use the words pain-free as I don't believe it really exists) when I woke - Now that's a first for more than 20 years! OK I haven't been very active yesterday, so it's a day I wouldn't expect to be TOO bad, but I wasn't expecting results this soon and was envisaging to need at least 20mcg patches before feeling this reasonable. Seems a bit too good to be true, and I am sitting here thinking "what's the catch?"

I only hope I get something near the full 7 days..... normally I seem to run out of pain relief very quickly on ANY opiate (eg only about 1.5 to 1.75 days on Fentabyl patches!)
 reid - scotland

31 Aug 2012

 hello there picton, i was on d.h.c. for 4 years 8x30 per day and baclofen,amitriptyline. and they started me on butrans. i started with 10mic first then moved up to the 20mic. for me they have been a god send. been on them over a year. i have 20 collapsed vertebrea with protusions and DDD through out. i am still left with pain wich i can live with,but the do taper of a little on day 6. and for some reason i find the relief drops a little on a friday. if your wondering why friday? well i put them on every wednesday morning. rather than that i find them good. you might find you are little hyper at times lol. and you do help with sleep a little bit. i still use the baclofen 3x10. and amitriptyline. so am not very sure if thats adding to it. cheers
 picton - West Midlands

1 Sep 2012

 Well Mickey 2414, I am on day 3 of the first 10mcg patch, and still OK, (and can't believe I am reasonable on that low a dose compared to the Fentanyl!) although maybe it is tailing off a little. (as I say, I seem to burn through ANY opiate far too quickly!)

Have noticed quite a decent sized red skin weal from the 5mcg patch I had on last week though still there - looks like I am going to look like a red and white chess-board after a few weeks - wouldn't mind, but I am not one for having sensitive skin, other than with zinc oxide plasters which make big lumps of skin pull off me! I actually panicked when I first saw a BuTrans patch as it looks JUST like a zinc oxide plaster!
 picton - West Midlands

1 Sep 2012

 Don't know why I addressed that last post specifically to Mickey 2414.... I must have accidentally pasted it! ;-)
 Sueinpain - Oldham

17 Sep 2012

 Email : 
 Hi everyone !!
i'm taking 15mg Bu-trans patches and finding only gives me 1 day pain relief 3-4 day after applying the patch !!!

Does anyone else have this problem ??

i am also taking tramadol 50mg but this is making me feel sick , woozy and only gives moderate pain relief.
I am changing the patches every 6 days !!!

What do other people take with bu-trans and what helps with break through pain ????
 picton - West Midlands

18 Sep 2012

 I am now on 15mcg worth of patches too, and have to say it has been a revelation to me: it's NOT a lot at that dose, they are not very potent *in theory* and to be honest isn't that much more equivalent strength to the Tramadol I was taking - I WAS briefly using 25mcg Fentanyl patch before this, a FAR higher equivalent dose and didn't care much at all for that, as I was almost high for 1 day, OK for the next half day and totally spent after this, facing 1.5 days of nothing ahead! :-(

The surprise to me has been the opposite you seem to find - Maybe your dose is not high enough yet to get better results?
I find I am surprised at how quickly they act - within a couple of hours, far faster than they are supposed to - and then *unfortunately* they start to run down after 4 to 5 days, however now I have managed to discontinue the Oxycodone for breakthrough pain (it clashes for me, and I even get unpleasant withdrawal symptoms when I mix the BuTrans and taking Oxy!) and replaced with 200mcg Temgesic, the short acting sub-lingual version of the drug that is in the patches,so for now I can get through with a combination. The Temgesic is not nearly as short acting as the Oxy either, so far easier to handle

From what I read, it's not "the done thing" to mix any weak opiates (such as Tramadol) and strong opiates such as BuTrans, so maybe worth asking for the same from your Doctor, then you would be on the same drug all the time, and able to get through with less ups and downs
 organiclemon - London

19 Sep 2012

 I use tramadol for breakthrough pain relief with paracetamol.I start with 50mg extra and if in an hour I need more my GP said I can take 50-100mg, I tend to stick to 100mg max as being already on 150mg tramadol, MST and BuTrans I a m reluctant to take more opioid. I have just increased the pregabalin to 100mg in the morning as well as 300mg at night with much reluctance but found it really helpful all round .
Next week I am reducing my Bu Trans again to 5mcg as I really want to come off the patch for mental health reasons. However GP said I may find i need to go back on it but can only try.
 picton - West Midlands

20 Sep 2012

 organiclemon, that doesn't make sense to me, maybe I am misinterpreting it!

Getting off BuTrans when you are taking Morphine and are also taking Tramadol sounds all mixed up - to me that sounds as odd as saying: come off the Weed but being on Crack is OK! ;-)

My own experience is that other opiates (of any sort) don't mix well with BuTrans, and that's well known (even though they often seem to be prescribed together) because of the antagonist effect of the BuTrans - and it means you need a fair bit more of the other opiate to get over that effect of the BuTrans before they work properly.

In any case, weak opiates and strong ones generally shouldn't be mixed in all the guidance I have come across... eg.

For me, once I got off the Oxycodone, I am finding I am coping with MUCH less total equivalent dosage of Buprenorphine - 15mcg/hr patch plus the odd 200mcg Tablet - compared to just a few weeks back using 25mcg/hr Fentanyl plus REGULAR 10mg Oxycodone, with the added benefit of now no withdrawal symptoms every 3 hours or so when the Oxycodone was wearing off.

OK, not everyone is going to get anything close to the same results, but the point I am making is mixing Buprenorphine with other opiates makes for some odd effects. I was getting nowhere while I was doing that instead of dropping the BuTrans, I'd try dropping the others and up the BuTrans
 Di - Lancashire

20 Sep 2012

 I find it strange that you mention withdrawal symptoms every 3 hours or so when the oxy is wearing off. I take the same oxycodone every 3 hours and on a good day often forget to take it until maybe 5 hours and have never had any withdrawal symptoms at all. I probably would if I stopped it completely but during normal use, nothing at all
 mrs hip - west country

21 Sep 2012

I have been using Butrans for quite a while and for me it has worked well. Initially I had a skin.reaction to the pad, the site was very sore,red weals etc. I was contemplating stopping using but read an article on the internet from a doc at the London Pain Clinic.He said lots of there clients had good results from rubbing a small amount of hydrocortisone 1%cream on the area to be used two hours before applying the patch.I have been doing this since then and have not had any further problems.
 organiclemon - London

23 Sep 2012

 Hi Picton
I agree re guidance. However I am being monitored by a consultant who in fact is very involved with the British Pain Society guidelines for non malignant pain. My GP is helpful as he has worked in substance misuse clinics so is experienced in this area and does say that it is time to reduce how many combinations. Hence reducing the bU Trans which was my choice to reduce first as withdrawal I have found the easiest compared to the MST and tramadol. I start the 5mcg patches next week-was too chicken this week! take care
 picton - West Midlands

24 Sep 2012

 Di - I find I seem to get through most opiates VERY quickly... Fentanyl was the worst, when I was starting to withdraw at about 1.5 days!!

Oxycodone, although it works fine for me, only seems good for about 3 hours, and that's after it's taken about 40 mins of that time to get going in the first place, then when you add in BuTrans to the equation, I seem to go into withdrawal rather than it just losing it's effect - in fact that's even BEFORE it's lost all analgesic effect :-(

So far so good on the "all-buprenorprhine" regime, and I have barely ha d to touch the sub lingual tablets, even on ONLY 15mcg worth of patches, which is very much less than the amount of Fentanyl I was needing.

The benefit is, (apart from less constipating) I am not clock-watching the way I was, and getting very wound-up in the process (I have OCD, and winding-up an obsessive is never a good thing!) ;-)
 picton - West Midlands

24 Sep 2012

 mrs hip - I have also read that (and rubbing on a steroid nasal spray such as Beconase which I have tried!). Using anti-histamine cream after removing the pad is apparently very good at taking out the itch too.

I was thinking of trying it as it might also help in removing the "glue" and stuck on fluff that it leaves behind too - I have avoided using alcohol wipes to do this, as the skin tends to be red enough to start with, and despite showering, it can last more than a week before it wears off.
 keyanne - portsmouth

31 May 2014

 Email : 
 hello, 3 weeks ago i was put on butrans but i am still in pain. pls can any one help me
 anniecat - fenland

1 Jun 2014

 Hi Keyann,

When I was first put on Butrans I was started on a very low dose - 5mcg. Gradually my gp raised the dose until it became effective. So I would get in touch with your gp and tell him/her and see if your dose can be increased until it becomes effective. I do hope it works well for you.

Annie x

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