Butrans vs Fentanyl – Comparison of Side Effects & Uses

Butrans

It is the brand name of a medication called buprenorphine transdermal (skin patch) that belongs to the class of medications called opioid analgesics or opioid partial agonist-antagonists.

The medication works by binding to certain opioid receptors in the body.

Uses

This prescription medication is used to treat moderate to severe, chronic, around-the-clock pain which will last a long period of time.

Note – it is not indicated as an as-needed analgesic.

Dosage

Treatment with this opioid analgesic begins with a 5 mcg/hour patch.

Change your patch at about the same time of day every time you change it. The patch is applied to the skin once every 7 days.

Side Effects and Precautions

Common side effects may include:

  • feeling tired;
  • vomiting;
  • a rash where the patch was worn;
  • nausea;
  • drowsiness;
  • itching;
  • constipation;
  • dizziness;
  • headaches.

Rare side effects may include:

  • a feeling like you might pass out;
  • deep sighs;
  • severe irritation where the patch was worn;
  • weak or shallow breathing;
  • swelling;
  • blisters;
  • seizure (convulsions);
  • feeling weak or tired;
  • fast heart rate;
  • loss of appetite;
  • chest pain;
  • jaundice (yellowing of the skin or eyes);
  • clay-colored stools;
  • dark urine;
  • upper stomach pain.

To make sure that this medication is safe for you, tell your healthcare provider if you have ever had:

  • seizures;
  • lung disease;
  • mental illness;
  • brain tumor;
  • urination problems;
  • drug addiction;
  • a head injury;
  • kidney disease;
  • alcoholism;
  • problems with the pancreas, gallbladder, or thyroid;
  • long QT syndrome;
  • heart rhythm problems;
  • liver disease.

Drug Interactions

It can negatively interact with many other drugs, especially:

  • phenobarbital (Solfoton) or other barbiturates;
  • dexamethasone (Decadron, Hexadrol);
  • HIV medication, like – etravirine (Intelence), efavirenz (Sustiva), or ritonavir (Kaletra, Norvir);
  • St. John’s wort;
  • prescription cough medicine;
  • jardiance;
  • other narcotic medications;
  • rifampin (Rifadin, Rifamate), rifabutin (Mycobutin), or rifapentine (Priftin);
  • drugs that affect serotonin levels in the body;
  • diazepam (Valium) or similar medicines, like – lorazepam (Ativan), alprazolam (Xanax), and others;
  • drugs that make you sleepy or slow your breathing;
  • seizure medications, like – felbamate (Felbatol), carbamazepine (Carbatrol, Tegretol), or primidone (Mysoline);
  • xiindra;
  • a heart rhythm medication, like –  disopyramide (Norpace), amiodarone (Cordarone, Pacerone), or sotalol (Betapace).

Alcohol

Do not drink alcoholic beverages while taking this opioid analgesic since dangerous side effects could occur.

Pregnancy & Breastfeeding

It should not be used in women who are breastfeeding because small amounts of this opioid analgesic may pass into breast milk and can negatively affect the infant. More importantly, it should not be used during pregnancy, especially in the third trimester.

Fentanyl

drug
Image credit – https://commons.wikimedia.org/wiki/File:Fentanyl_Transdermal_System_50_mcg_Patch.jpg

It is a synthetic opioid analgesic that is about 50 times more potent than heroin and 100 times more potent than morphine.

This medication can be found under the brand-name Duragesic, a transdermal (through the skin) patch.

It was originally approved by the US The Food and Drug Administration in 1968 and is manufactured by Johnson & Johnson.

Uses

It can be used:

  • in patients who are already opioid-tolerant or who are already taking narcotic analgesics;
  • for pain management in individuals who have persistent, moderate-to-severe chronic pain requiring continuous, around-the-clock opioids;
  • for the management of breakthrough cancer pain in individuals who are already receiving opioid medication for underlying, persistent pain;
  • as anesthesia for individuals with poor heart function or for individuals undergoing heart surgery.

Dosage

The usual recommended dose is 25-100 mcg/hr, reapplied q72hr until adequate analgesia is achieved.

Do not use a patch that is damaged, cut, or changed in any way because if you use damaged or cut patches, you may receive most or all of the medication at once.

Side Effects and Precautions

Common side effects may include:

  • insomnia;
  • diarrhea;
  • feeling cold;
  • constipation;
  • fatigue;
  • vomiting;
  • anorexia;
  • nausea;
  • headaches;
  • increased sweating;
  • dizziness;
  • drowsiness.

Rare side effects may include:

  • hallucinations;
  • depression;
  • euphoria;
  • abnormally slow heart action;
  • tingling sensations;
  • reduced sense of touch;
  • muscle spasms and tremors;
  • eczema;
  • urinary problems;
  • confusion;
  • fluid retention;
  • sexual and erectile dysfunction;
  • anxiety;
  • abdominal pain.

Pregnancy & Breastfeeding

Because this medication is excreted in breast milk, do not use it if you are breastfeeding.

Moreover, prolonged use of this opioid analgesic during pregnancy can produce drug dependence in newborns. Also, the drug may prolong labor.

Alcohol

Drinking alcoholic beverages while taking this opioid analgesic may cause profound sedation, low blood pressure, respiratory depression, coma, and even death.

Drug Interactions

It may negatively interact with other medications, especially:

  • Carbamazepine (Carbatrol, Epitol, Tegretol);
  • antihistamines;
  • Nalbuphine (Nubain);
  • barbiturates, like – phenobarbital (Luminal);
  • Naloxone (Narcan);
  • Buprenorphine (Buprenex, Subutex);
  • Nevirapine (Viramune);
  • Butorphanol (Stadol);
  • naloxone;
  • Oxcarbazepine (Trileptal);
  • Efavirenz (in Atripla, Sustiva);
  • Phenytoin (Dilantin, Phenytek);
  • Modafinil (Provigil);
  • Rifampin (Rifadin, Rimactane);
  • Nalmefene (Revex);
  • sleeping pills, sedatives, or tranquilizers;
  • oral steroids, like – methylprednisolone (Medrol), dexamethasone (Decadron, Dexpak), and prednisone;
  • Rifabutin (Mycobutin);
  • Pioglitazone (Actos, in Actoplus Met);
  • Pentazocine (Talwin);
  • other pain medications.

Addiction & Abuse

It may be habit-forming. Do not apply more patches or use the patches in a different way than prescribed by your healthcare provider.

In addition, this medication is a very short-acting drug which means it quickly becomes addictive to people who want to maintain their high.

The Drug Enforcement Administration classifies this opioid analgesic as a Schedule II controlled substance. This means it has a high potential for abuse, and its use could be dangerous.

Withdrawal

As with other addictive drugs, stopping this opioid analgesic suddenly may result in withdrawal symptoms, including:

  • enlarged pupils;
  • difficulty falling asleep or staying asleep;
  • anxiety;
  • yawning;
  • weakness;
  • restlessness;
  • a fast heartbeat and rapid breathing;
  • a runny nose;
  • diarrhea;
  • sweating and chills;
  • vomiting;
  • back pain;
  • loss of appetite;
  • nausea;
  • stomach cramps.

Bottom Line – Butrans vs Fentanyl

Butrans skin patch (active ingredient – buprenorphine) is an opioid pain medication that is used for around-the-clock treatment of moderate to severe chronic pain which is not controlled by other medicines.

Fentanyl (brand name – Duragesic) is an opioid skin patch that is only used for opioid-tolerant patients for the pain management in individuals who have persistent, moderate-to-severe chronic pain requiring continuous, around-the-clock opioids.

References

https://www.pbm.va.gov/PBM/clinicalguidance/drugmonographs/Buprenorphine_Transder
https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drug
https://www.sciencedirect.com/science/article/pii/S1063458411001075

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