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Overview: Buprenorphine is used to treat opioid use disorder or to help manage severe pain. It works by partially activating the same receptors in your body that opioids do. Common side effects include nausea or vomiting, dizziness, sleepiness, headache, and constipation. Serious side effects are less common but include dental problems, trouble breathing, and a risk of addiction. Buprenorphine comes in several forms, including a film that dissolves in your mouth or a tablet that dissolves under your tongue. It can also be given as an injection by a health care provider.

Uses

What is buprenorphine used for?

Buprenorphine is commonly used for the following conditions.

  • Opioid use disorder, to help people reduce or stop their use of opioids. Examples of opioids include prescription pain medicines, like oxycodone, and illicit drugs, like heroin.  
  • Management of severe pain when other types of treatments do not work. 

These uses may vary depending on the specific buprenorphine product prescribed.

Buprenorphine may also be used for other conditions as determined by your health care provider.

How does buprenorphine work (mechanism of action)?

Buprenorphine works by partially turning on the same receptors in your body that opioids do. This helps ease withdrawal symptoms and cravings in people with opioid use disorder. This is also how buprenorphine helps reduce the feeling of severe pain. 

How is buprenorphine supplied (dosage forms)?

Brands and other names

  • Belbuca
  • Buprenex

Dosage forms and strengths

  • 2 mg, 8 mg sublingual tablets
  • 75 mcg, 150 mcg, 300 mcg, 450 mcg, 600 mcg, 750 mcg, 900 mcg buccal film

Buprenorphine is also available in injectable forms that are given by a health care provider.

See also: Buprenorphine transdermal (Butrans), Sublocade (buprenorphine), Brixadi (buprenorphine)

How should I store buprenorphine?

Oral Film and Oral Tablet. Buprenorphine oral film or tablet should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Injection Liquid. Buprenorphine injection is given by a health care provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of buprenorphine?

The most common side effects of buprenorphine are listed below. These side effects may vary depending on the buprenorphine product you are using. Tell your health care provider if you have any of these side effects that bother you.

  • Nausea or vomiting
  • Constipation
  • Dizziness, drowsiness, tiredness, or trouble sleeping
  • Headache
  • Pain, tingling, numbness, redness, or a burning feeling in your mouth with the oral form
  • Swelling of your hands or feet
  • Excessive sweating
  • Injection site reactions with the injectable form (see below)
  • Kidney or bladder infection

There may be other side effects of buprenorphine that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of buprenorphine?

While less common, the most serious side effects of buprenorphine are described below, along with what to do if they happen.

Severe Allergic Reactions. Buprenorphine may cause allergic reactions, which can be serious. Stop using buprenorphine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Increased Pain and Pain Sensitivity. Buprenorphine may cause allodynia, which is when you have pain from something that normally does not cause pain, such as brushing your hair. Buprenorphine may also cause hyperalgesia, which is when you are very sensitive to pain. Contact your health care provider right away if you have pain from things that did not cause pain before or if you have worsening pain or are more sensitive to pain. It is very important to not use more buprenorphine if your pain feels worse, as this may cause breathing problems or other serious side effects.

Breathing Problems. Buprenorphine may cause slow or shallow breathing, especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Tell your health care provider right away if you develop severe sleepiness or trouble breathing, especially when you start buprenorphine or when your dose is increased. Get emergency help if you have any of the following symptoms.

  • Changes in the color of your skin, including bluish color to your lips and fingernails
  • Confusion
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
  • Slow or shallow breathing
  • Excessive sleepiness or trouble staying awake 

Reduced Adrenal Function. Buprenorphine may cause your body’s adrenal glands to stop making as much cortisol (the stress hormone). This is known as adrenal insufficiency. Adrenal insufficiency can get worse if your body is under stress because of fever, surgery, or trauma. Tell your health care provider if you have any of the following symptoms of adrenal insufficiency.

  • Nausea and vomiting
  • Weakness, tiredness, or lack of energy
  • Low blood pressure

Low Blood Pressure (Hypotension). Buprenorphine may cause low blood pressure, including a sudden drop in blood pressure when standing up from a seated or lying position (orthostatic hypotension). To help prevent this, be careful not to get up too quickly. If you feel faint or dizzy, sit or lie down until the dizziness stops, then take your time getting up again. Tell your health care provider right away if you have any of the following symptoms of low blood pressure.

  • Dizziness, feeling lightheaded, or fainting
  • Confusion
  • Feeling weak or tired

Risk of Misuse and Addiction. Misusing buprenorphine can lead to serious side effects like coma or death. Misuse means using a medicine in a way other than how it was prescribed. Use buprenorphine exactly as prescribed. Tell your health care provider if you feel that buprenorphine is not working. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures
  • Trouble breathing

Liver Damage. Liver damage, also called hepatotoxicity, can happen when using buprenorphine, especially if you have or are at risk for liver disease. Keep all appointments with your health care provider to check your blood work before and during treatment. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Dental Problems. Buprenorphine oral film or tablets may cause problems with your teeth, which can sometimes be severe. Keep all appointments with your dentist and tell them you are taking buprenorphine. Call your health care provider if you notice any of the following symptoms of dental problems. 

  • New or worsening cavities in your teeth
  • Tooth decay
  • Infection or abscess in your teeth or mouth
  • Loss of fillings
  • Broken or lost teeth

Central Nervous System (CNS) Depression. Buprenorphine may slow down your central nervous system (CNS), which controls many vital functions throughout the body. Call your health care provider right away if you have any of the following symptoms of CNS depression.

  • Confusion
  • Excessive sleepiness or trouble staying awake
  • Memory problems
  • Slow or shallow breathing
  • Slowed response or reaction time
  • Slurred speech

Injection Site Reactions. Buprenorphine given by injection may commonly cause some mild discomfort, redness, bruising, itching, or swelling near where it is injected. Rarely, severe reactions can happen. Contact your health care provider right away if you have any reaction that concerns you, does not get better, or gets worse over time, especially if you have any of the following symptoms near the injection site.

  • An infection, such as an abscess or cellulitis 
  • An open wound
  • A lot of swelling
  • Blisters
  • Intense pain
  • The area is hard or lumpy
  • A dark scab

Warnings & Precautions

Who should not use buprenorphine?

Allergies to Ingredients. People who are allergic to any of the following should not use buprenorphine.

  • Belbuca
  • Buprenorphine
  • Buprenex
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific buprenorphine products they stock.

Lung Problems. Certain forms of buprenorphine should not be used if you have severe asthma, trouble breathing, or other lung problems. Buprenorphine can make these conditions worse.

Gut Blockage. Certain forms of buprenorphine should not be used if you have a blockage of your gut (bowel obstruction) or a narrowing of the stomach or intestines. Buprenorphine can make these conditions worse.

What should I know about buprenorphine before using it?

Do not use buprenorphine unless it has been prescribed to you by a health care provider. Use it as prescribed. 

Do not share buprenorphine with other people, even if they have the same condition as you. It may harm them.

Keep buprenorphine out of the reach of children. Buprenorphine may cause children to have serious breathing problems or to stop breathing if they use it by accident. 

Buprenorphine is a controlled substance because it can be misused or lead to dependence. Store buprenorphine in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

People using buprenorphine should have naloxone available in case of an emergency. Buprenorphine is a type of opioid and may cause a bad reaction where your breathing slows or potentially stops. Naloxone is a medicine used to reverse the effects of opioids. Your health care provider can tell you how to use and where to get naloxone. You should teach your family, friends, and caregivers when and how to use naloxone in case of an overdose. If naloxone is used, be sure to call 911. 

Buprenorphine is available in many different forms that are used in different ways. Ask your health care provider to show you how to use buprenorphine properly. Read and follow the instructions for the product you have. Taking this medicine the wrong way can cause serious side effects or may make it not work as well. 

If you are taking buprenorphine oral film or tablet, after it has completely dissolved in your mouth, rinse your mouth with water and then swallow it. You should wait at least one hour after taking the buprenorphine film or tablet before brushing your teeth. These steps can help lower the chance of tooth problems from buprenorphine.

Buprenorphine can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how buprenorphine affects you.

Buprenorphine can cause physical dependence, which means your body relies on the medicine. If you stop buprenorphine suddenly, it could lead to withdrawal symptoms, which may require you to go to the hospital. Physical dependence is not necessarily a sign that you have developed a substance use disorder. Do not stop using buprenorphine without talking with your health care provider. Your health care provider can tell you how to stop buprenorphine to reduce the risk of withdrawal reactions. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sweating
  • Shaking more than normal 
  • Feeling more hot or cold than normal
  • Runny nose
  • Watery eyes
  • Goosebumps
  • Vomiting or diarrhea
  • Muscle aches

You should tell all of your health care providers that you are using buprenorphine. Also tell your family, friends, or caregivers to let all of your health care providers know that you are using buprenorphine in an emergency. Buprenorphine can cause life-threatening problems when used with certain medicines or anesthesia.

When buprenorphine is used to treat opioid use disorder, it works best when combined with counseling, behavioral therapy, and support. Buprenorphine can be used for as long as you feel it is helping for opioid use disorder. Keep all counseling appointments your health care provider recommends. If you want to stop using buprenorphine, call your health care provider. 

Throw away expired, unwanted, or unused buprenorphine right away by taking it to a local take-back site. If one is not available, ask your health care provider how to throw your medicine away safely.

People who are 65 or older can be at greater risk for some side effects from buprenorphine. Talk to your health care provider about your risks if you are in this age group.

Using buprenorphine for a long time may affect your ability to become pregnant or get a partner pregnant. Talk with your health care provider if you have any concerns.

What should I tell my health care provider before using buprenorphine?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if buprenorphine is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have or have had any of the following.

Other Medicines and Supplements. Buprenorphine may interact with other medicines and supplements. Before using buprenorphine, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Buprenorphine may cause harm to an unborn baby. If you use buprenorphine during pregnancy, your baby may have withdrawal symptoms that can be life-threatening if not treated. Tell your health care provider if you are or plan to become pregnant, or if you used buprenorphine while pregnant. Your health care provider will advise you if you should use buprenorphine while you are pregnant or trying to get pregnant.

Breastfeeding. Buprenorphine passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will advise you if you should use buprenorphine while breastfeeding.

Interactions

Does buprenorphine interact with foods or drinks?

There are no known interactions between buprenorphine and foods or nonalcoholic drinks.

Do not use buprenorphine with alcohol or with over-the-counter medicines that contain alcohol. Using buprenorphine with alcohol may cause breathing problems that may be life-threatening.

Does buprenorphine interact with other medicines (drug interactions)?

  • A benzodiazepine, such as clonazepam (Klonopin), diazepam (Valium and others), or lorazepam (Ativan and others), which is a medicine used for anxiety, muscle spasms, or seizures
  • An opioid, such as oxycodone, morphine, codeine, fentanyl, or butorphanol, which is a medicine used for certain types of pain
  • A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
  • Any other medicines that contain buprenorphine (such as Butrans)
  • A muscle relaxant, such as carisoprodol (Soma), cyclobenzaprine, metaxalone, or tizanidine (Zanaflex)
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • Erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
  • A medicine for HIV or AIDS
  • Ketoconazole, which is a medicine used for fungal infections
  • Carbamazepine (Carbatrol, Tegretol, and others) or phenytoin (Dilantin, Phenytek, and others), which is a medicine commonly used to treat seizures 
  • Rifampin, which is a medicine commonly used to treat an infection called tuberculosis
  • A selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI), which is a medicine commonly used for anxiety and depression
  • A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
  • A triptan, such as eletriptan (Relpax), sumatriptan (Imitrex and others), and others, which is a medicine commonly used to treat migraines
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, or medicines for anxiety

Many other medicines may alter the blood levels of buprenorphine. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with buprenorphine. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much buprenorphine?

If you or someone else has used too much buprenorphine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222. 

It is also important to have naloxone on hand in case of an opioid overdose. Be sure that you and your family, caregivers, and friends know how to recognize an opioid overdose and how to use naloxone. See the Warnings & Precautions section for more details.

What should I do if I miss a dose of buprenorphine?

If you miss a dose of oral buprenorphine, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose at the regular time. Do not take double or extra doses unless your health care provider tells you to. Ask your health care provider if you are not sure.

If you miss a dose of injectable buprenorphine, contact your health care provider as soon as possible to receive your next dose.