Buprenorphine Side Effects
Applies to buprenorphine: injection solution. Other dosage forms:
Warning
Injection route (Solution)
Use of buprenorphine hydrochloride increases the risk of opioid addiction, abuse, or misuse, which may cause overdose or death. Assess the risk prior to therapy and monitor for signs of addiction, abuse, or misuse during therapy. Serious, life-threatening, or fatal respiratory depression may occur, particularly at treatment initiation and with dose increases. Monitor for signs of respiratory depression during treatment. Prolonged use during pregnancy may result in neonatal opioid withdrawal syndrome, which may be life-threatening if unnoticed and untreated. If prolonged use is required in a pregnant woman, advise the patient of the risk to the fetus. Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for patients with inadequate alternative treatment options. Limit dosages and durations to the minimum required, and follow patients for signs and symptoms of respiratory depression and sedation.
Serious side effects of Buprenorphine
Along with its needed effects, buprenorphine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking buprenorphine:
More common
- Drowsiness
- relaxed and calm feeling
- sleepiness
Rare
- Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- bluish color of the fingernails, lips, skin, palms, or nail beds
- blurred vision
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- chest pain, discomfort, or tightness
- confusion
- difficult or labored breathing
- feeling, seeing, or hearing things that are not there
- feeling that others are watching you or controlling your behavior
- feeling that others can hear your thoughts
- headache
- severe mood or mental changes
- slurred speech
- unusual behavior
Incidence not known
- Agitation
- anxiety
- cough
- darkening of the skin
- deep or fast breathing with dizziness
- diarrhea
- dizziness
- dry mouth
- fainting
- fever
- irregular heartbeats
- irritability
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- loss of appetite
- loss of muscle coordination
- nausea
- nervousness
- noisy breathing
- overactive reflexes
- poor coordination
- restlessness
- seizures
- shaking
- shivering
- skin rash
- sweating
- talking or acting with excitement which you cannot control
- trouble sleeping
- twitching
- unusual tiredness or weakness
- vomiting
Get emergency help immediately if any of the following symptoms of overdose occur while taking buprenorphine:
Symptoms of overdose
- Blurred vision
- confusion
- difficult or trouble breathing
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- irregular, fast or slow, or shallow breathing
- pale or blue lips, fingernails, or skin
- pinpoint pupils
- relaxed and calm
- sleepiness or unusual drowsiness
- sweating
- unusual tiredness or weakness
Other side effects of Buprenorphine
Some side effects of buprenorphine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
- Constricted, pinpoint, or small pupils (black part of the eye)
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- extremely shallow or slow breathing
- sweating
Rare
- Burning, dry, or itching eyes
- chills
- continuing ringing or buzzing or other unexplained noise in the ears
- decrease in the frequency of urination
- decrease in urine volume
- depression
- difficulty in passing urine (dribbling)
- discharge, excessive tearing
- dreaming
- dry mouth
- false or unusual sense of well-being
- fast, pounding, or irregular heartbeat or pulse
- feeling of warmth
- hearing loss
- itching of the skin
- painful urination
- pounding in the ears
- redness of the face, neck, arms, and occasionally, upper chest
- redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
Incidence not known
- Belching
- bloated
- bluish lips or skin
- change in vision
- excess air or gas in the stomach or intestines
- feeling of fullness
- feeling of unreality
- general feeling of discomfort or illness
- heartburn
- hives or welts
- impaired vision
- indigestion
- not breathing
- paleness of the skin
- passing gas
- redness of the skin
- sense of detachment from self or body
- stomach discomfort, upset, or pain
For Healthcare Professionals
Applies to buprenorphine: buccal film, compounding powder, injectable solution, subcutaneous solution extended release, subdermal implant, sublingual tablet, transdermal film extended release.
Cardiovascular
Common (1% to 10%): Vasodilation, hypotension, peripheral edema, hypertension, palpitations
Uncommon (0.1% to 1%): Orthostatic hypotension, tachycardia, angina pectoris, flushing, bradycardia, cyanosis, , QT prolongation
Frequency not reported: Wenckebach block[Ref]
QT prolongation has been observed. In clinical trials of buprenorphine buccal film (n=1590), post-baseline QTcF values of 450 to 480 milliseconds were observed in 2% of patients at doses up to 900 mcg every 12 hours. In a QT study in healthy subjects, therapeutic doses (10 mcg/hour transdermal patch) had no effect on the QTc interval, but higher doses (40 mcg/hour) were associated with a mean prolongation of 5.9 milliseconds.
During clinical trials, serial ECGs were collected to evaluate the effect of extended-release subcutaneous administration of buprenorphine on QT prolongation. Seven patients showed a greater than 60 msec increase QTc from baseline. One patient had a QTc greater than 500 msec. These QTc findings were reported as sporadic and transient and none led to aberrant ventricular rhythm. Review of ECG and adverse event data showed no evidence of syncope, seizure, or ventricular tachycardia or fibrillation.[Ref]
Dermatologic
Very common (10% or more): Application site pruritus (up to 15%), sweating (up to 13%), application site erythema (up to 10%)
Common (1% to 10%): Application site rash, application site irritation, hyperhidrosis, pruritus, rash, generalized pruritus
Uncommon (0.1% to 1%): Contact dermatitis, application site dermatitis, dry skin, facial edema, urticaria, pallor
Very rare (less than 0.01%): Pustules, vesicles
Frequency not reported: Injection site reaction, angioedema, application site edema[Ref]
Endocrine
Opioids:
Postmarketing reports: Adrenal insufficiency, androgen deficiency[Ref]
Cases of androgen deficiency have been reported with chronic use of opioids. Adrenal insufficiency has been reported with opioid use, especially with use of 1 month or longer.[Ref]
Gastrointestinal
Very common (10% or more): Nausea (up to 23%), constipation (up to 14%), abdominal pain (11.7%), diarrhea (up to 10%)
Common (1% to 10%): Vomiting, dyspepsia, dry mouth, stomach discomfort, upper abdominal pain, flatulence
Rare (0.01% to 0.1%): Diverticulitis, dysphagia, ileus, heartburn
Very rare (less than 0.01%): Retching[Ref]
Genitourinary
Common (1% to 10%): Urinary tract infection, dysmenorrhea
Uncommon (0.1% to 1%): Urinary incontinence, urinary retention
Rare (less than 0.1%): Urinary hesitation, decreased erection, sexual dysfunction[Ref]
Hematologic
Common (1% to 10%): Lymphadenopathy
Hepatic
Common (1% to 10%): Increased ALT, increased AST, increased gamma-glutamyl transferase (GGT)
Rare (less than 0.1%): Biliary colic
Frequency not reported: Hepatitis, jaundice, hepatic failure, hepatic necrosis, hepatorenal syndrome, hepatic encephalopathy, transaminases increased[Ref]
Hypersensitivity
Uncommon (0.1% to 1%): Allergic reaction
Rare (0.01% to 0.1%): Anaphylactic responses
Very rare (less than 0.01%): Serious allergic reactions[Ref]
Anaphylaxis has been reported with ingredients contained in the implant. Anaphylaxis has been reported with ingredients contained in extended-release subcutaneous injection.[Ref]
Local
Very common (10% or more): Implant site pain (13%), implant site pruritus (12%), implant site erythema (10%)
Common (1% to 10%): implant site hematoma, implant site hemorrhage, implant site edema, injection site pain, injection site pruritus, injection site erythema, injection site induration
Uncommon (0.1% to 1%): Injection site bruising, injection site swelling, injection site discomfort, injection site reaction, injection site cellulitis, injection site infection[Ref]
Metabolic
Common (1% to 10%): Anorexia
Uncommon (0.1% to 1%): Dehydration, loss of appetite, weight decreased
Postmarketing reports: Neonatal feeding disorder[Ref]
Musculoskeletal
Very common (10% or more): Back pain (up to 16%)
Common (1% to 10%): Arthralgia, pain in extremity, muscle spasm, musculoskeletal pain, joint swelling, neck pain, myalgia, chest pain, leg cramps, bone pain, general spasm, muscle weakness, increased creatine phosphokinase (CPK)
Uncommon (0.1% to 1%): Muscle cramps, rigors, muscle spasm
Very rare (less than 0.01%): Muscle fasciculation, ear pain[Ref]
Nervous system
Very common (10% or more): Headache (up to 34%)
Common (1% to 10%): Dizziness/vertigo, nervousness, somnolence, hypoesthesia, tremor, migraine, paresthesia, syncope, hypertonia, dysgeusia, exanthema, sedation
Uncommon (0.1% to 1%): Tinnitus, concentration impairment, coordination abnormal, dysarthria, memory impairment, restlessness, sedation, sleep disorder, slurred speech, coma
Rare (less than 0.1%): Disequilibrium, numbness
Frequency not reported: Convulsions
Postmarketing reports: Neonatal tremor, serotonin syndrome[Ref]
Ocular
Common (1% to 10%): Runny eyes, miosis, mydriasis, lacrimation disorder
Uncommon (0.1% to 1%): Dry eye, vision blurred, conjunctivitis
Rare (less than 0.1%): Eyelid edema, visual disturbance
Frequency not reported: Diplopia, visual abnormalities, amblyopia[Ref]
Other
Very common (10% or more): Pain (up to 26%), asthenia (up to 16%)
Common (1% to 10%): Chills, fever, accidental injury, fatigue, pyrexia, fall, malaise, tiredness, lethargy
Uncommon (0.1% to 1%): Edema
Frequency not reported: Death[Ref]
Psychiatric
Very common (10% or more): Insomnia (up to 28%), withdrawal syndrome (up to 24%), anxiety (up to 14%), depression (up to 13%)
Common (1% to 10%): Hostility, agitation, paranoid reaction, thinking abnormal, confusion
Uncommon (0.1% to 1%): Affect lability, depersonalization, libido decreased, nightmare, euphoric mood, psychosis, hallucination, euphoria
Very rare (less than 0.01%): Dependence, mood swings
Frequency not reported: Dreaming
Postmarketing reports: Neonatal withdrawal syndrome[Ref]
Respiratory
Very common (10% or more): Rhinitis (up to 15%)
Common (1% to 10%): Cough increased, pharyngitis, upper respiratory tract infection, influenza, sinusitis, bronchitis, dyspnea, pharyngolaryngeal pain, hypoventilation, yawning
Uncommon (0.1% to 1%): Asthma aggravated, hiccups, hyperventilation, hypoxia, wheezing, apnea
Rare (less than 0.1%): Respiratory depression, respiratory failure
Postmarketing reports: Asphyxia[Ref]
Frequently asked questions
- How long does opioid withdrawal last?
- How long does buprenorphine stay in your system?
- What are the different brands of buprenorphine?
- What is the difference between Sublocade and Brixadi?
- What are the different types of buprenorphine/naloxone?
- How long do you take buprenorphine for?
- Is Buprenex the same as buprenorphine?
More about buprenorphine
- Check interactions
- Compare alternatives
- Pricing & coupons
- Reviews (1,113)
- Drug images
- Latest FDA alerts (5)
- Dosage information
- Patient tips
- During pregnancy
- Support group
- Drug class: Opioids (narcotic analgesics)
- Breastfeeding
Patient resources
Other brands
Belbuca, Subutex, Sublocade, Butrans, ... +3 more
Professional resources
- Buprenorphine monograph
- Buprenorphine Injection (FDA)
- Buprenorphine Patch (FDA)
- Buprenorphine Sublingual (FDA)
Other brands
Belbuca, Sublocade, Butrans, Brixadi, ... +2 more
Related treatment guides
References
1. (2001) "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc
2. (2002) "Product Information. Subutex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc
3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
4. Cerner Multum, Inc. "Australian Product Information."
5. (2010) "Product Information. Butrans (buprenorphine)." Purdue Pharma LP
6. (2016) "Product Information. Probuphine (buprenorphine)." Braeburn Pharmaceuticals
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Some side effects may not be reported. You may report them to the FDA.