What is the equivalent transdermal (through the skin) patch dose of buprenorphine (Subutex) for a patient taking 900mcg sublingually (SL) (under the tongue) twice a day (BID)?

From the Guidelines

For a patient taking 900mcg of buprenorphine (Subutex) sublingually twice daily, the equivalent transdermal patch dose would be 35mcg/hour, as the maximum daily dose for transdermal buprenorphine is 140mcg/h, but the starting dose is typically between 17.5-35mcg/h, and given the patient's current dose, the higher end of the starting dose range is more appropriate. This recommendation is based on the conversion between sublingual and transdermal formulations of buprenorphine, as seen in the study by 1. The transdermal patch delivers medication continuously over a 7-day period, so one patch would be applied weekly. When transitioning from sublingual to transdermal buprenorphine, it's essential to monitor the patient closely for withdrawal symptoms or signs of overmedication during the first few days after switching, as noted in the study by 1.

Some key points to consider when making this conversion include:

• The bioavailability of buprenorphine differs between sublingual and transdermal routes, which affects the dosing, as mentioned in the study by 1.
• The patient should be instructed to apply the patch to clean, dry, non-irritated, non-hairy skin, typically on the upper arm, upper chest, upper back, or side of the chest.
• Transdermal buprenorphine has proven efficacy and may be safer than full opioid agonists in the treatment of chronic pain, as seen in the systematic review by 1.
• If the maximum dose of transdermal buprenorphine is reached, consideration should be given to adding or replacing it with an additional long-acting potent opioid, as noted in the study by 1.

It's crucial to prioritize the patient's safety and adjust the dose accordingly to minimize the risk of overmedication or withdrawal symptoms. The study by 1 provides guidance on the management of chronic pain in patients taking buprenorphine, which is essential in making informed decisions about the conversion to transdermal buprenorphine.

From the Research

Equivalent Transdermal Patch Dose

To convert buprenorphine 900mcg SL BID to a daily transdermal patch dose, we need to consider the equivalent dosage of buprenorphine in micrograms per hour (mcg/h) for the transdermal patch.

• The total daily dose of buprenorphine is 900mcg x 2 = 1800mcg.
• According to the study 2, the buprenorphine transdermal delivery system (TDS) has dosages of 35.0,52.5, and 70.0 microg/h.
• Another study 3 mentions a buprenorphine transdermal system (BTDS) delivering 5,10, or 20 mcg/hour for seven days.
• However, to find the equivalent transdermal patch dose, we need to consider the total daily dose of buprenorphine and the duration of the patch.

Calculation of Equivalent Transdermal Patch Dose

• Assuming a 24-hour duration for the sublingual dose, the total daily dose is 1800mcg.
• To calculate the equivalent transdermal patch dose, we can use the following formula: (total daily dose) / (duration of patch in hours).
• However, the provided studies do not give a direct conversion from sublingual to transdermal patch dose.
• But we can consider the study 4 which compared the efficacy and safety of low-dose 7-day buprenorphine patches (5,10, and 20 microg/h) with prolonged-release tramadol tablets.

Available Transdermal Patch Doses

• Based on the available transdermal patch doses mentioned in the studies, the closest dose to the calculated equivalent dose would be:

• 20 microg/h (as mentioned in study 3 and 4)

• However, the exact equivalent dose cannot be determined without more specific information about the conversion from sublingual to transdermal patch dose.

Limitations

• The provided studies do not give a direct conversion from sublingual to transdermal patch dose.
• More research is needed to determine the exact equivalent transdermal patch dose for buprenorphine 900mcg SL BID.
• It is recommended to consult a healthcare professional for proper dosage conversion and treatment planning, as mentioned in studies 5, 3, 2, 6, and 4.