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Butrans(Buprenorphine) and other Opiods

Ive been on the Butrans 10mcg patch for about a year now. In addition to the round-the-clock patch ive been taking 5-10mg of Norco about once every1-2 days. The patch works so well for me the BT meds only need to be minimal.

So I went to go pick up my usual prescription of Norco and the head pharmacist comes out to me and told me he was confused why I was taking hydrocodone with the Butrans. He said that Butrans is both a agonist and antagonist for opiate receptors so it gives pain relief but also blocks other painkillers from working. He said that it will make the Norco work significantly less but I told him I never had a problem with it. He still gave me the medication as normal but gave me a print-out explaining how buprenorphine interacts with hydrocodone.

The print out sheet stated that buprenorphine MAY limit the effectiveness of the hydrocodone. So it seems its not an absolute rule and I could be the exception.
I still think the Norco works just fine for me, plus my Doctor prescribing has an extra degree in pharmocology so I dont think he would mess up on something like this.

Has anyone ever noticed the interaction/cancelling effect of buprenorphine? or are you like me where it seems to work fine concurrently with other painkillers?


  • LovetrotravelLLovetrotravel Posts: 296
    edited 08/03/2012 - 4:23 AM
  • I had written out a post to the wrong thread....LOL

    To my knowledge of what I have read....Bup (for short..) only effects the brain and other opiates when it is given in high doses. It used to be that it was given to those who are addicts and trying to recover.

    But in the doses in the Butrans patch comes in...it shouldn't have any negative effects and why many like yourself is also on a breakthrough opiate.

    I'm certainly not a medical professional so may not be explaining it correctly but you can look online if you research Bup and it's history.
  • Hi, I have been on buprenorphine for chronic pain for many years and am quite familiar with the way it works, having discussed it at length with my doctors. It is a 'partial agonist' at the mu opioid receptor, not an antagonist. In low-medium doses it acts like a 'pure' mu opioid receptor agonist, similar to morphine.

    As the information that came with your prescription states, it is quite safe to take other mu opioid receptor agonists with it for breakthrough pain. It has an additive effect rather than an antagonistic effect (recent studies have established this). Unfortunately, there are still some outdated misconceptions about buprenorphine. There is probably more confusion surrounding this drug than any other opioid, due to its unique pharmacology and the fact that it is now used for two distinct purposes: its original use as a pain reliever, and its more recent role in treating addiction.

    One of the biggest misconceptions is that it will block the effect of any other opioid. In practice, this doesn't happen, at least not in therapeutic analgesic doses. I have been prescribed it for a long time along with other opioids for breakthrough pain including morphine, dihydrocodeine, tramadol, oxycodone etc., and have never had a problem. In very high doses there could possibly be some problem, but not in the relatively low doses used for pain management, according to the pain management literature. Any decrease in analgesic effect would more likely be caused by tolerance, rather than any theoretical antagonistic effect.
  • Recently found a study on this that showed Buprenorphine has the opiate blocking effect at doses of 2mg or more. I calculated it and the 10mcg Butrans patch at most will have a .5mg concetration of the drug in your system at one time, so the Butrans should have no interactions at all since its such a low dose.
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