9 Butrans Side Effects To Know About

Butrans (buprenorphine) is a transdermal (skin) patch that treats chronic pain. It's a partial opioid agonist that’s long-acting — each patch is designed to be worn for 7 days at a time. It’s typically prescribed by a pain management specialist when other pain medications aren’t working or can’t be used.

While Butrans is often considered less risky than typical opioids, it still has risks to keep in mind. Here, we’ll cover nine notable Butrans side effects and how to minimize or manage them. 

Good to know: Other forms of buprenorphine, such as a buccal film called Belbuca, also treat chronic pain. And other buprenorphine products treat opioid use disorder (OUD), including sublingual tablets (formerly Subutex), extended-release injections (Sublocade, Brixadi), and the sublingual film Suboxone (which contains buprenorphine and naloxone). However, in this article, we’ll discuss Butrans only.

Butrans side effects at a glance

Using Butrans correctly and at the lowest effective dose will help minimize side effects. An experienced healthcare professional can offer guidance and determine the right dose for you. 

Common, often mild Butrans side effects include:

• Nausea and vomiting

• Dizziness

• Headache

• Skin irritation at the application site

• Tiredness and fatigue

• Trouble sleeping

• Constipation

• Dry mouth

• Mood changes

• Increased sweating

• Swelling

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More serious Butrans side effects include:

• Severely low blood pressure

• Adrenal problems

• Heart rhythm problems

• Impaired ability to drive or do other activities, which can lead to injuries and accidents 

• Liver damage

• Severe constipation in people with bowel obstruction (blockage in the intestines)

• Increased risk of seizures in people with seizure disorder

• Increased sensitivity to pain

• Opioid withdrawal symptoms, which may be severe in some cases

This medication also has a few boxed warnings. This is the FDA’s strictest warning for medications. While rare, these side effects can be severe in some cases, and even life-threatening. Butrans warnings include:

• Misuse

• Slowed breathing and overdose, especially when combined with other substances that slow breathing — such as alcohol, other opioids, and benzodiazepines 

• Overdose in people who are accidentally exposed to Butrans, especially children

• Withdrawal symptoms in newborns who were exposed to Butrans during the mother’s pregnancy

1. Nausea and vomiting

Nausea and vomiting are common Butrans side effects.

Nausea is a common side effect of all opioids, even partial opioid agonists such as Butrans. Luckily, there are a few things you can try at home to help settle your stomach. Instead of eating large meals, try eating smaller, more frequent meals or snacks throughout the day. And avoid fatty or spicy foods, which can make nausea worse. Additionally, stay hydrated, as not drinking enough water can also worsen or cause nausea.

In some cases, over-the-counter (OTC) or prescription nausea medications may be helpful to keep nausea at bay. But talk to a healthcare professional first. Some nausea medications can interact with Butrans.

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• Can therapy help with chronic pain? Yes. Here are the types of therapy that can treat chronic pain.

2. Dizziness

Dizziness is a common Butrans side effect. It’s more likely to happen when you start taking Butrans or your dose is increased.

While dizziness can be its own Butrans side effect, it can also occur due to orthostatic hypotension, which can also happen with Butrans. This is when your blood pressure drops too low during position changes, such as getting out of bed or standing up. It can cause you to feel dizzy or light-headed, which can lead to falls and injuries. This can be particularly dangerous for older adults, who are more likely to experience injury or disability from falls.

If you’re feeling dizzy while taking Butrans, be sure to move slowly when changing positions. You may need to sit or lie back down if you feel dizzy when standing up. 

If your dizziness is severe or doesn’t go away, let your prescriber know. They may ask you to check your blood pressure at home. Additionally, they may want to further evaluate the cause of your dizziness. Dizziness can sometimes be a sign of rare, but serious Butrans side effects, including extremely low blood pressure, adrenal insufficiency, or long QT syndrome (a type of abnormal heartbeat).

3. Headache

Headache is another commonly reported Butrans side effect. If you experience headaches, consider at-home headache remedies, such as hydration, exercise, or meditation. Sometimes dietary changes can also help. 

If your headaches continue, talk to your prescriber about which pain medications are safe to combine with Butrans. They might give you the OK to try an OTC pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil).

Keep in mind that you should avoid using opioids to treat your headache. Butrans can block other opioid medications, making them less effective at providing pain relief. Combining Butrans and other opioids can also put you at a higher risk for an overdose. 

4. Skin irritation

Since Butrans patches are applied directly to the skin, irritation at the application site can happen. This can include redness, itching, and rash.

Applying Butrans correctly helps minimize this side effect. This includes rotating the area of your body where you apply the patch each week. Options include the upper outer arm, upper chest, side of the chest, and upper back.

Butrans can be applied to these sites on either side of the body. That means you have eight possible areas to place your patch. Butrans should be rotated among these eight sites. In fact, you should wait a minimum of 3 weeks before applying a Butrans patch to the same site.

Make sure the area you apply the patch to is free of cuts and irritation, such as rashes or redness. Applying Butrans to irritated areas can make you more likely to experience further irritation.

5. Drowsiness and fatigue

Another common Butrans side effect is tiredness and fatigue. It’s more likely to happen when you first start taking Butrans or if your prescriber increases your dose. Be aware that this side effect can affect your ability to complete tasks that require focus, such as driving. That’s why you shouldn’t perform tasks that require alertness when first starting Butrans or after a dose increase. Once you see how Butrans affects you, talk with your prescriber to see if it's safe to resume these activities.

Although much less common, some people taking Butrans report insomnia. And not sleeping well at night can contribute to daytime drowsiness. Talk with your prescriber if Butrans is interrupting your sleep. And consider trying a few sleep-promoting habits, such as going to bed and waking up around the same time each day.

6. Constipation

Constipation is a common opioid side effect, and Butrans is no exception. Constipation from opioids doesn’t always improve over time.

It’s best to try to prevent constipation before it happens by staying hydrated, eating fiber-rich foods, and exercising regularly. Some OTC laxatives can also be helpful. But talk to your pharmacist or prescriber about which laxative is best for you. Not all OTC laxatives work well for opioid-induced constipation (OIC). Some commonly used options include docusate sodium (Colace, DocQLace), senna (Senokot, Ex-Lax), and bisacodyl (Dulcolax), or a combination such as Senna-S (docusate / senna).

In some cases, your prescriber may recommend prescription laxatives, such as Movantik (naloxegol) or Relistor (methylnaltrexone).

7. Withdrawal

Even though Butrans isn’t a “full” opioid, it can still cause opioid withdrawal symptoms. Withdrawal symptoms can occur in people who suddenly stop taking an opioid or decrease their dose too quickly, especially after taking opioids for an extended period of time. Examples of withdrawal symptoms include nausea, diarrhea, and increased sweating. Anxiety and restlessness can also occur.

Additionally, initiating Butrans too quickly after stopping another opioid can cause withdrawal. This is because Butrans binds more tightly to opioid receptors than full opioids. So if you start taking it too soon after taking an opioid, it can block that opioid’s effects and trigger withdrawal symptoms.

Whether you’re starting or stopping Butrans, don’t do so without talking to your prescriber first. They can give you instructions for how to minimize your risk of experiencing withdrawal symptoms.

8. Misuse

All opioids are controlled substances with a risk of causing dependence and misuse. However, Butrans is a Schedule 3 controlled substance, and full opioid medications (such as hydrocodone-containing or oxycodone-containing medications) are Schedule 2. This means Butrans has a lower risk of dependence and misuse than full opioids.

To minimize your risk of Butrans misuse, follow your prescriber’s instructions for how to use it. Don’t apply extra patches or apply patches more often than prescribed. You should also avoid using other opioids unless instructed to do so by your prescriber. 

Talk to your prescriber if you feel Butrans isn’t controlling your chronic pain. They may recommend increasing your dose or trying another medication. But don’t make any changes without talking to them first.

9. Overdose

An opioid overdose can occur when the amount of opioids in your system is too high. While overdose is less likely with Butrans than other opioids, it can still happen. The risk is higher if you apply the patch differently than you’re supposed to. So be sure to follow instructions on how to place patches. Never use a patch that has been cut or damaged, and avoid applying the patch to broken skin. 

Additionally, protecting your patch from heat is important. If Butrans becomes too hot, too much medication can get into your system, putting you at risk for overdose. Showering and bathing are still OK, but avoid excess heat while wearing Butrans. This includes using hot tubs, saunas, and heating pads. In addition, avoid electric blankets, heat or tanning lamps, and prolonged direct sunlight.

A Butrans overdose is also more likely if you take certain medications or substances while wearing your patch. Even at normal or low doses, combining Butrans and other medications with sedative-like properties can slow your breathing. This is why you shouldn’t combine Butrans with:

• Benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan)

• Other opioids, such as oxycodone (Oxycontin, Roxicodone) and tramadol (ConZip, Qdolo)

• Alcohol

Be sure your healthcare team knows about the other medications you’re taking, so they can make sure it is safe for you to take Butrans. 

How to respond to an overdose

An overdose is a medical emergency. Administer naloxone (Narcan, Zimhi) or nalmefene (Opvee, Zurnai) immediately if you have them. These are medications that can quickly reverse the effects of an opioid overdose. Naloxone is also available OTC as a nasal spray. Nalmefene products are available by prescription only. 

Keep in mind that even if naloxone or nalmefene seem to help, the effects are temporary and the person overdosing still needs emergency care at a hospital. So call 911 immediately after administering the first dose of these medications.

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Written by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Bailey E. Eason, PharmD, MS, BCPS

Bailey Eason has been licensed for 6 years and has held licenses in three states (North Carolina, Virginia, and Illinois). She has held positions as a health-system pharmacy administration resident, operating room pharmacy manager, pharmacy manager of clinical operations: surgery, neurology and controlled substances, and most recently as program director  of drug diversion for a large academic health system.

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