Is transdermal (through the skin) buprenorphine available in Ontario, Canada?

Availability of Transdermal Buprenorphine in Ontario, Canada

Yes, transdermal buprenorphine is available in Ontario, Canada, as it is recognized in clinical guidelines as an effective treatment option for chronic pain management, including cancer-related pain. 1

Formulations and Dosing Available

Transdermal buprenorphine is available in the following dosages:

• 5 μg/h (lowest available dose) - recommended for opioid-naïve patients 2
• 10 μg/h - for dose titration when 5 μg/h provides insufficient analgesia 1
• 20 μg/h - maximum recommended dose according to FDA guidelines due to QT prolongation concerns 2

Higher doses that were studied in earlier research (35 μg/h, 52.5 μg/h, and 70 μg/h) 3 are not currently recommended due to safety concerns.

Clinical Applications

Transdermal buprenorphine is indicated for:

• Chronic moderate to severe pain, including:
  • Cancer-related pain 2
  • Chronic non-cancer pain 4
  • Osteoarthritis pain 1
  • Chronic low back pain 5

Advantages of Transdermal Buprenorphine

1. Unique Pharmacology: As a partial μ-opioid agonist, buprenorphine has:

   • A ceiling effect on respiratory depression (but not on analgesia) 1
   • Lower risk of overdose compared to full μ-opioid agonists 1

2. Patient Convenience:

   • Once-weekly administration (7-day patch) 4
   • Consistent plasma drug concentrations throughout the dosing interval 4

3. Special Populations Benefits:

   • No dosage adjustments needed in elderly patients 4
   • Safe in patients with renal impairment 2, 4
   • May be especially appropriate for treating cancer pain in patients with renal impairment 2

Efficacy Data

• 90% of patients report at least satisfactory pain relief with transdermal buprenorphine in long-term studies 6
• Significantly lower pain intensity scores compared to placebo in chronic low back pain (45.3 vs 53.1 mm on VAS) 5
• Comparable pain relief to other opioids like transdermal fentanyl and morphine, but with fewer adverse events 1

Common Side Effects

The most common adverse effects include:

• Systemic effects: nausea (9.2%), dizziness (4.6%), vomiting (4.2%), constipation (3.8%) 6
• Local skin reactions: erythema (12.1%), pruritus (10.5%), exanthema (8.8%) 6

Important Clinical Considerations

1. Dose Conversion: Converting from other opioids to buprenorphine can be complex; consider pain specialty consultation for complex cases 2

2. Breakthrough Pain Management: Adjuvant therapies (non-opioid analgesics, topical agents) may be added rather than immediately increasing the patch dose 1

3. Cautions:

   • Maximum recommended dose of 20 μg/h due to QT prolongation concerns 2
   • May precipitate withdrawal symptoms if administered to individuals currently taking high-dose opioids 2

Transdermal buprenorphine represents an effective option for pain management in Ontario, offering advantages in terms of safety profile, convenience, and efficacy for patients with chronic moderate to severe pain.