Buprenorphine Pain Patch and Side Effect Management

The Patient

A patient called our specialty pharmacy inquiring about side effects from a buprenorphine patch he had been using for a few months to manage chronic back pain. He informed us that the patch had greatly helped to reduce his pain, but he had noticed a little redness and blistering on the application site. The patient was inquiring about what to do regarding this side effect.

His current medication list:

• venlafaxine 150 mg at night (depression)

• hydrochlorothiazide 25 mg daily (hypertension)

• atenolol 50 mg daily (hypertension)

• simvastatin 40 mg at night (cholesterol)

• pantoprazole 40 mg daily (GERD)

• acetaminophen and oxycodone 1 to 2 tablets every 4 to 6 hours as needed for pain

• buprenorphine 10 mcg/hour patch

• multivitamin 1 tablet daily

The patient is a 50-year-old male. He informed us that in 2012 and 2014, he had failed back surgeries and experiences constant back pain. He had tried a fentanyl patch in the past but did not like the way it made him feel drowsy throughout the day. His pain management physician switched him to a buprenorphine patch, which he has been using for a couple of months now. This patch calls for a 7-day application with alternating sites on the body. For the past week, the patient has been noticing redness and blistering at the site of application. He asked for any tips to help prevent this from occurring.

I asked the patient how he was currently applying the buprenorphine patch to ensure the method was done as indicated. The patient informed me that he applied the patch on his upper chest and changed the site of application after 7 days. He informed me that, sometimes, he forgot to change the application site and used the same site for the next set of 7 days.

I informed him of a few steps that could help with irritation and redness. I counseled him on choosing an area of dry, non-hairy skin for application (upper outer arm, upper back, upper chest, or the side of the chest), and applying hydrocortisone cream a few hours before applying the patch. (If the application area is hairy, one can clip the area with scissors but should not shave the area.) I also informed him that it’s important to not reuse a site that has had the patch for a few weeks. If there is continual irritation, redness, and blistering at the site application, I suggested he contact his pain management physician and inform him of these side effects to potentially change to another treatment option.

After implementing these changes, the patient saw reduced redness and blistering at the site of application. He stated the steroid cream helped to relieve side effects as well.

Understanding how a patient is using a medication, including transdermal applications, can help with proper counseling and medication administration advice. In this particular scenario, it is important to have a good grasp of the transdermal system and administration to properly counsel the patient.

During this counseling session, I emphasized the importance of proper application of the patch. As pharmacists, it is important that we pay attention to detail and be able to help our patients with medication administration leading to beneficial outcomes.