Norfolk and Suffolk NHS Foundation Trust
Pharmacy, Hellesdon Hospital, Norwich, NR6 5BE
http://www.nsft.nhs.uk/

Esther Johnston
01603-421452
esther.johnston@nsft.nhs.uk

Medication: Buprenorphine

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Buprenorphine is also known by the brand names Subutex®, Prefibin® and Suboxone® tablets. All these are sub-lingual tablets i.e. they have to be placed under the tongue to be absorbed. They don't work if you swallow the tablets as the buprenorphine is destroyed by the acid in the stomach. Subutex® and Prefibin® just contains buprenorphine. Suboxone® contains buprenorphine and naloxone. Buprenorphine is also available for pain relief as an injection (Temgesic®), a lower dose tablet for pain (Temgesic®) and as a patch for the skin (BuTrans®, Transtec®).

An implant (a small solid rod) that goes under the skin and lasts for 6 months (to be called Probuphine®) is being developed by Titan Pharmaceuticals in USA and may be available in the UK in the late 2010s.

Buprenorphine is available in many countries e.g. Australia, Republic of Ireland and UK. It was first used in the UK in 1980 as a pain-killer (Temgesic®), and first licensed for substance misuse in 1999.

If you want to see all the questions and answers in full, click the "Show answers too" button.

Updated 12.14

  • Where can I print information about buprenorphine?

    There are two options for printing:

    • Click "Print this page" at the top to print the whole section
    • For a full range of leaflets please click here, or for Suboxone click here.
    • This includes our range of leaflets, fact sheets, handy charts and links to the manufacturer's leaflets
  • WHAT IT IS:
  • What is buprenorphine used for?

    Buprenorphine has several uses:

    1. Opiate dependence to help people get off opiates such as heroin, morphine and methadone. It should be used with social help, medical help and psychological help.
    2. As a pain killer, in lower doses

    Reviewed 2.14

  • What is the usual dose of buprenorphine?

    The usual dose of buprenorphine for opiate dependence is between 4mg a day and 24mg a day. If you are stopping buprenorphine, the dose should be reduced gradually over several weeks or months.

    The dose should be started at 0.8mg to 4mg. It can then be increased depending how well you get on with it.  

    It is not recommended in children under 16 but this is only because it has not been studied rather than because of any concerns about safety.

    Buprenorphine can actually be taken every 2 days, with double the daily dose taken every other day. This is not often done in the UK as the double dose is usually more than the maximum daily dose in UK.

    Reviewed 4.13

  • What are the differences between buprenorphine and methadone?

    Buprenorphine and methadone are the two main medicines used to help people get off opiates and stay off them. Methadone is used most often but buprenorphine is used sometimes. At the moment, the price of buprenorphine is much higher than methadone so this is the main reason why methadone is used more. Suboxone has buprenorphine and naloxone (see above). For your information, the table below compares the two:

     

    Advantages

    Disadvantages

    Methadone

    The volume and low strength make it is unlikely to be injected.
    It is a direct replacement for opioids such as heroin so (although you are unlikely to get a ‘high' from it you will still get some opiate effects like emotional numbing, sedation and pain relief) at the right dose it will prevent opiate withdrawal symptoms
    Supervision of doses are quicker
    Methadone has used for opiate dependence for many years and there is lots evidence that it helps
    An antidote is easily available if you overdose
    It helps stop withdrawal symptoms
    At the moment it is thought to be the better substitute therapy in pregnancy
    Methadone comes as a liquid (including sugar-free), tablet and an injection

     

    Methadone seems harder to come off at the end of treatment
    The syrup doesn't taste very nice. The sugar version is very sickly and if you are on a high dose the amount you have to swallow can be quite high
    Street methadone is easier to be adulterated i.e. diluted or mixed with other things
    Most people know what methadone is for so being on it can be stigmatising
    Methadone slows (and can stop) breathing causing death (overdose). This is most likely to happen when your body is getting used to it so finding the right dose for you needs to be done carefully and can take a few days or even weeks.
    Overdose is also more likely if you mix methadone with other sedative drugs like benzodiazepines, pregabalin or alcohol    
    The sugary methadone liquid can cause tooth decay
    Methadone is more sedating than buprenorphine
    Methadone has more drug interactions than buprenorphine
    Methadone needs to be avoided in some people with heart problems
    If you are taking more than 100mg a day you should have heart tests (to check on your QTc)

    Buprenorphine

    Buprenorphine comes as a tablet so is easier to transport
    Safer in overdose
    It is less sedating than methadone and so people who work often prefer it to methadone
    Easier to wean off at the end of treatment
    Can sometimes be used less than once per day

    It can be harder to get stable at the beginning of treatment - starting buprenorphine can cause withdrawal symptoms if there is still a lot of opiate in your system. You need to be in withdrawal before you take the first dose and some people find this too uncomfortable.    
    Some people try injecting the tablets, which is very dangerous
    May have to use different strengths of tablets to get the right dose
    Tablets can take a while to dissolve under the tongue so supervised consumption takes longer
    The tablets don't taste that great either
    You can get a sudden withdrawal effect if started too soon
    Does not work if the tablet is swallowed
    Opiates may not work, if you need them for pain, childbirth etc 

    Suboxone(R)

    As for buprenorphine plus
    Does not work if injected

     

    As for buprenorphine plus
    If Suboxone is injected after using heroin or other opioids then you can quickly get withdrawal symptoms 

    For a handy fact sheet comparing methadone and buprenorphine click here

    Updated 2.14

  • How does buprenorphine work?

    When you take an opiate, it stimulates opiate receptors in your brain. This in turn releases dopamine in the reward centres of your brain and this gives you the good feeling. Buprenorphine is a "partial agonist" at opiate receptors in the brain. This means that it hits these receptors and partly blocks them, but also partially stimulates them. What this means in practice is that buprenorphine blocks the effect of any opiates you might take but because it stimulates the receptors a bit it stops you getting withdrawal effects. It also puts a "ceiling" on how much effect you can get from anything you take.

    Suboxone® works the same as Subutex® but also contain naloxone (see below).

    Reviewed 4.13

  • STARTING, TAKING AND STOPPING:
  • When should I take buprenorphine?

    You should take your buprenorphine every day. The time of day doesn't really matter, but most people find the morning better.

    What you mustn't do is start buprenorphine if you've been taking opiates recently (6 hours for heroin or 24 hours for methadone). This is because buprenorphine will push the opiates off the receptors and push you into withdrawal. 

    Click here for a handy fact sheet on taking medicines during Ramadan.

    Updated 4.14

  • How should I take buprenorphine?

    Don't swallow it! Buprenorphine is absorbed very quickly from the stomach but unfortunately the liver metabolises or breaks it down almost completely the first time it passes through the liver. So, the tablets have to be placed under the tongue so the buprenorphine can be absorbed and go straight to the brain before it gets to the liver.

    Place the tablet under your tongue (sublingually) and allow it to dissolve slowly. This takes about 5-10 minutes. Some services crush the tablets before giving them. This means the buprenorphine is absorbed in a couple of minutes.  

    Suboxone® also contains naloxone. Naloxone is an opiate antagonist usually used to help people who can't breath properly after an overdose of opiates. It also blocks the effect of buprenorphine but the naloxone is not absorbed if you take it under the tongue so has no effect when taken properly. However, anyone injecting naloxone will find that the naloxone works when injected, so causes instant opiate withdrawal. It is sometimes used to stop people injecting the tablets. 

    Please don't try injecting Subutex®, Prefibin® or Suboxone®. When you crunch up the tablets, there are always a few little bits left. If you inject these, they get stuck in veins and arteries. These block them up, and then that area of your body dies. When it dies, you can get infections and even gangrene. If you value your legs and arms, do not inject these tablets.  

    Updated 4.13

  • How long will buprenorphine take to work?

    Buprenorphine sub-lingual tablets starts to work in a few minutes, and peak after about 90 minutes. The effect lasts for about 2 days.  

    For more information about opiate dependence click here

    Reviewed 2.14

  • How long will buprenorphine need to be taken for?

    You should carry on with buprenorphine until you feel ready to come off it. Your key worker and doctor will help you with this. Whilst you are on buprenorphine you should try to make the changes in your life that will allow you to feel ready to detox. Although buprenorphine is not harmful, being on it means you are still physically addicted to opiates. Coming off it frees you from this addiction and can change you way you feel about yourself, and the way other people think about you, in a positive way.  

    There is a little more information on opiate dependence so click here

    Updated 2.14

  • Is buprenorphine addictive?

    For a drug to be addictive or produce dependence, then it must have a number of characteristics:

    • should produce craving for the drug when the last dose "wears off"

    • there should be a "reward" (e.g. a good feeling) from taking the drug

    • should produce tolerance ie you need more drug to get the same effect

    • should produce withdrawal symptoms specific to that drug.

    These characteristics come from the World Health Organisation. Buprenorphine is addictive as it can cause withdrawal effects. However, these are probably less than with other opiate drugs.

    Reviewed 4.13

  • What should I do if I forget to have a dose of buprenorphine?

    Start again as soon as you realise, unless it is within a few hours of your next dose. Don't take two doses at the same time to make up for this. 

    If you have not had your buprenorphine for a few days (especially if it is more than 3 days) your body's ability to cope with the dose may have reduced, which can be dangerous. Talk to your doctor or key worker before taking it. It may be better to take a smaller dose and see how you feel.

    Updated 4.13

  • Can I stop taking buprenorphine suddenly?

    You should not stop buprenorphine suddenly, because you can get withdrawal symptoms, similar to heroin withdrawal.

    If you are thinking of coming off this medicine then you might find our handy fact sheet on stopping medicines useful. It has a list of many of the things you may need to think about before making a decision on this.

    Updated 6.13

  • UNWANTED EFFECTS:
  • What sort of side-effects might I get if I am taking buprenorphine?

    The table below will show you some of the main side effects you might get from buprenorphine.

    Side effect

    What happens

    What to do about it

    COMMON (about 1 in 10 people might get these)

    Constipation

    When you want to poop but can't (the opposite of diarrhoea). You can't pass a motion.

     

    Make sure you eat enough fibre, cereal or fruit. Make sure you are drinking enough fluid. Make sure you keep active and get some exercise e.g. walking. If this does not help, ask your doctor or pharmacist for a mild laxative.

    Headaches

    Your head is pounding and painful.

    Try paracetamol. Your pharmacist will be able to advise if this is safe to take with any other medicines you may be taking.

    Sleepiness

    Feeling sleepy, drowsy or sluggish. It can last for a few hours after taking your dose.

    This can happen early on treatment and often means your dose is too high. This can be dangerous so talk to your doctor or key worker. You may need a lower dose.

    Insomnia

    Not being able to fall asleep at night

    Discuss this with your doctor. He/she may be able to change the time of the dose or doses.

    Asthenia

    Muscle weakness, tiredness and feeling unwell

    Discuss with your doctor. It should wear off after a few weeks.

    Nausea and vomiting

    Feeling sick and being sick.

    If you are feeling sick for more than a week, contact your doctor. This tends to wear off after a few days or so.

    Fainting and dizziness

    Feeling light-headed and faint.

    Don't stand up too quickly. Try and lie or sit down if you feel it coming on. A change in dose may help. Discuss this with your doctor.

    Postural hypotension

    Feeling dizzy or faint after standing up

    Don't stand up too quickly. Don't drive. Talk to your doctor about this if it goes on for more than a few weeks.

    Sweating

    Feeling hot and sticky, particularly at night.

    Let your doctor know next time you meet. It is not dangerous but he or she may be able to adjust your dose(s).

    Miosis

    Constricted pupils e.g. the black bit in the middle of the eye is very small

    Discuss with your doctor. It should wear off a bit after a few weeks.

    Sexual dysfunction

    Male ejaculatory failure

    Discuss with your doctor.

    RARE BUT IMPORTANT (less than about 1 in 1000 people might get these)

    Allergic reaction

    Sudden wheezing, difficulty breathing, swelling eyes, face, tongue, lips, throat or hands, itching.

    See your doctor immediately, straight away, this can be dangerous.

    Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

    Updated 4.13

  • Will buprenorphine make me sleepy?

    Buprenorphine is a sedative drug. This effect is most likely when you first start taking it and should settle with time. If you feel very sleepy it means you are on too much which can be very dangerous. This can happen:

    • At the start of treatment if the dose has been put up too quickly
    • If you are taking another sedative drug with it
    • If you are unwell
    • If you have started taking a drug which interacts with buprenorphine (see section about other medications below).

    Try taking a smaller dose and talk to your doctor or key worker.

    Updated 4.13

  • Will buprenorphine cause me to put on weight?

    No, but some people who have been taking street drugs (like heroin) before starting buprenorphine have not been eating much and are underweight. Once settled on buprenorphine people often start to eat more regularly which can cause (healthy) weight gain. This is due to lifestyle change rather than the buprenorphine itself. 

    If you are a woman, being underweight and have chaotic drug use this can cause periods to stop. On buprenorphine, your fertility may return before your periods start again so make sure you are using adequate contraception.

    Click here for a few tips on how to help you feel less hungry and lose weight.

    Reviewed 4.13

  • Will buprenorphine affect my sex life?

    Buprenorphine may cause some problems, but probably less than methadone and probably less than street opiates. It can cause low libido (sex drive) and ejaculatory delay (not "coming"). This seems to be worse in younger men and tends to get better over 3 months (Jones, 2012). So if you have problems, give it 3 months and if it still hasn't improved then you can seek help.

    Updated 10.13

  • INTERACTIONS, FOOD AND DRINK:

    Please see the separate medicines.

  • Are there any foods or drinks that I should avoid if I am taking buprenorphine?

    No, other than alcohol. As far as we know there is no problem with drinking grapefruit juice with buprenorphine.

    Reviewed 4.13

  • Can I drink alcohol while I am taking buprenorphine?

    Whether or not it is safe to drink alcohol with any medicine will depend on:

    • How much you have to drink e.g. the amount and over how long
    • What you then try to do (e.g. sleep or drive)
    • If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
    • If you are taking any other medicines

    Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

    You must not drink alcohol with buprenorphine because this can stop you breathing.  

    It is not safe to drive after drinking alcohol, with or without buprenorphine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

    Reviewed 4.13

  • Will buprenorphine affect my other medication?

    Buprenorphine has a number of interactions with other medicines:

    • Buprenorphine must not be used with benzodiazepines (e.g. diazepam, lorazepam, temazepam) because this can stop you breathing. It should not be taken with the MAOIs, a class of antidepressants.

    • Talk to your doctor if you are prescribed any treatments for AIDS, phenobarbital, carbamazepine, or phenytoin as some of these mean your dose may need to be changed

    • Buprenorphine increases the sedation caused by anything else that causes sleepiness e.g. alcohol, antipsychotics, sleeping tablets, other opiates, barbiturates, antihistamines, clonidine, some antidepressants, sedatives etc.

    • Buprenorphine decreases the effect of some HIV (AID) treatments

    • Some medicines increase the effect of buprenorphine: e.g. ketoconazole (for fungal infections), which slows the metabolism of buprenorphine, so if you need to take ketoconazole, your dose of buprenorphine needs to be halved. Some AIDS treatments can increase buprenorphine's effects.

    This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just means that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions.

    Reviewed 4.13

  • Are there any problems with smoking with buprenorphine?

    Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with buprenorphine.

    Reviewed 4.13

  • What about illicit drugs such as cannabis, cocaine, ecstasy and opiates with buprenorphine?

    By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

    Cannabis (illegal in most countries):

    Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with buprenorphine.

    Cocaine (illegal in most countries)

    Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with buprenorphine and cocaine, although this doesn't mean it's safe.

    Ecstasy (illegal in most countries)

    Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with buprenorphine and ecstasy, but again this doesn't mean it's safe.

    Opiates

    The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs; diamorphine and morphine for pain). Buprenorphine and an opiate will make you sleepier, can stop you breathing and give you "postural hypotension" (where you stand up and feel very dizzy). You should not take other opiates with buprenorphine.

    Reviewed 4.13

  • WOMEN'S HEALTH:
  • If I am on the contraceptive pill, how will buprenorphine be affected?

    You should have no problem with the Pill and buprenorphine.

    As mentioned above, being underweight and with chaotic drug means your periods can stop. If you start buprenorphine your fertility may return before your periods start again so make sure you are using adequate contraception.  

    Reviewed 4.13

  • Will emergency contraception (the "morning-after pill") work if I am taking buprenorphine?

    In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

    If you are taking buprenorphine, the usual dose should work if you follow the instructions carefully.

    N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

    Reviewed 4.13

  • Will buprenorphine affect my periods (menstrual cycle)?

    Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

    Luckily buprenorphine doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

    As mentioned above, being underweight and with chaotic drug means your periods can stop. If you start buprenorphine your fertility may return before your periods start again so make sure you are using adequate contraception.  

    Updated 4.13

  • What if I want to start a family or find I'm pregnant while taking buprenorphine?

    Firstly, don't panic and don't stop taking it suddenly. Opiate withdrawal can cause miscarriage or pre-term labour.

    Secondly, although there is more evidence on the safety of methadone there are more and more studies and research trials showing that buprenorphine seems to be safe in pregnancy and lots of women have had healthy babies taking buprenorphine. If there is any risk that you will relapse into using street drugs (or alcohol) if you come off it, then it is better for you and for your baby to keep taking it. This is because:

    • Using street drugs means your blood levels vary frequently so the baby is swinging between intoxication and withdrawal - just like you are. This is bad for development and can cause miscarriage.
    • Street drugs may contain things you don't know about and can harm the baby.

    Babies born to mums on street heroin have far more problems than those born to mums on buprenorphine.

    If you are taking buprenorphine your baby may (or may not) have some withdrawal symptoms after birth. These can be treated. It does not mean that your baby is ‘born an addict'. In fact there is no evidence that this causes long-term problems or makes it more likely your child will grow up to use drugs. The quality of your parenting and what they see you doing has much more impact on this; so it is better if you are stable on treatment than be chaotic and relapsing.

    Alcohol, cocaine and other stimulants are far more dangerous for your baby than buprenorphine. Alcohol is the commonest cause of preventable brain damage in babies. Smoking also causes babies not to grow as well, which can put them at risk of problems like Cot Death. Stopping smoking and drinking may help your baby more than coming off buprenorphine.

    If you'd like to read more:

    It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed its main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

    It may be helpful to know that in the USA, the FDA (Federal Drug Administration) classifies medicines in pregnancy in five groups:
    A = Studies show no risk, so harm to the unborn child appears only a remote possibility
    B = Animal and human studies indicate a lack of risk but are not fully conclusive
    C = Animal studies indicate a risk but there is no safety data in humans
    D = a definite risk exists but the benefit may outweigh the risk in some people
    X = the risk outweighs any possible benefit

    Buprenorphine is classed as "C". The baby might also start withdrawing from buprenorphine after being born. You would need to talk to your doctors about this because taking buprenorphine when you give birth needs to be done very carefully. An extensive review comparing buprenorphine with methadone shows that buprenorphine is a little safer for the baby e.g. less effect on the heart, less withdrawal symptoms and no teratogenicity (Jones, 2012).

    If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

    Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

    Updated 4.14

  • Can I breast-feed if I am taking buprenorphine?

    Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

    If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

    If you want to breast-feed there are some things you can do to reduce any risk:

    • Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.

    • Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.

    • Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter

    • Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit

    • Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half

    • Avoid new medicines if possible as there is less information about them and breast-feeding.

    You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

    Although buprenorphine passes in to breast milk it is not active if swallowed so it is unlikely to affect your baby much at all. The down side of this is that (unlike methadone) it will not help much if your baby is experiencing withdrawal symptoms. Most street drugs and alcohol also pass in to breast milk so continue to avoid these while breast feeding.  

    Updated 4.13

  • OTHER QUESTIONS AND ANSWERS:
  • Can I drive while I am taking buprenorphine?

    You must not drive and you must inform the DVLA if you start taking buprenorphine or your insurance may not be valid.

    Buprenorphine can cause drowsiness and initially can reduce your reaction times, especially if you take alcohol or other sedatives at the same time. This could cause you to have an accident putting yourself and others at risk. A French study has also shown that there appears to be double the risk of a road crash involving injuries on the day of a buprenorphine dose, possibly due to the drug or risky behaviours (Corsenac 2012). So, you really must not drive when taking buprenorphine.

    If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

    Click here for a handy fact sheet on driving and medication.

    General advice on driving safely

    If you want to drive, you should take sensible steps to reduce any risk. These could include:

    • Avoid driving when you are tired or ill
    • Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
    • Avoid driving at night, dusk or in bad weather
    • Avoid motorways, dual carriageways and the rush hour
    • Give yourself plenty of time. Don’t rush
    • Be extra careful if you have not slept well the previous night

    As some medicines can affect your driving, be extra careful:

    • If starting a new medicine
    • After a change in dose (especially an increase)
    • If you are on a high dose or seem very sensitive to side effects
    • If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
    • If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

    If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

    Updated 3.15

  • Will I need any blood or other tests while I am taking buprenorphine?

    You might need a blood test before you start buprenorphine to make sure you don't have hepatitis or any liver problems.

    Reviewed 4.13

  • Where can I find more information about buprenorphine?

    A. Medicines and Healthcare products Regulatory Agency (MHRA)

    In 2012 the UK Medicines and Healthcare products Regulatory Agency set up a Medicines Safety Information part of their website. You will have to search for the medicine or medicines you want to look for. The parts you might find of interest are as follows:

    Drug Analysis Prints (DAPs)

    DAPs contain a complete list of all possible side effects that have been reported by healthcare professionals and patients to the MHRA, via the Yellow Card Scheme. Each DAP lists all of the reactions reported by health professionals and patients for a particular medicine.

    • C&M note: Please be careful reading this section. It includes all possible side effects listed against every medicine someone was taking. So, if all your hair fell out while you were taking 5 medicines, this event would be listed against all five medicines, even though only one or even none might have been the cause. The idea is to try to get all information and perhaps find some rare side effects. The numbers of reported cases also depend on how often the medicine is prescribed e.g. 50 reports based on 500 prescriptions is worth looking at, but 5 cases based on 5,000,000 prescriptions could well just be chance.

    Public Assessment Reports (PARs)

    The MHRA's assessment of a medicine can be found in the Public Assessment Reports (PARs), although commercial and personal confidential information has been taken out. PARs are usually available for medicines licensed in the UK after 30 October 2005.

    Summaries of Risk Management Plans

    A Risk Management Plan (RMP) is a document that describes all the available knowledge about the safety and effectiveness of a medicine.

    Drug Safety Update (DSU)

    Drug Safety Update is the MHRAs monthly newsletter for healthcare professionals. It has information and clinical advice on the safe use of medicines.

    Summaries of Product Characteristics (SPCs) and patient information leaflets (PILs)

    This page contains the official product information. Every medicine pack includes a patient information leaflet (PIL), which provides information on using the medicine safely. PILs are based on the Summaries of Product Characteristics - a description of a medicinal product's properties and the conditions for its use. These are also linked from the leaflets question above.

    B. European Medicines Agency (EMA)

    The European Medicines Agency (EMA) is the body that approves medicines for use in the EU. The EPAR is all the scientific stuff put in a readable way. It explains how and why the Committee for Medicinal Products for Human Use (CHMP) looked at the information on each drug and decided to allow it to be marketed ("granting a marketing authorisation" as the call it). 

    Updated 7.12

  • What if I am travelling abroad from UK?

    If you are prescribed a Controlled Drug e.g. methadone or buprenorphine, in UK you will need a Home Office personal licence to take it out of the country and bring any back in again. NHS Choices have a webpage giving advice to UK residents about this called "Can I take controlled medicines abroad?". You need to apply for the licence at least 10 working days before you travel. Your GP will need to provide a letter of support. It has no legal status in other countries.

    Updated 7.12

The Norfolk & Suffolk NHS Foundation Trust (NSFT) Pharmacy Services exist to proactively support staff, service uses and carers in achieving safe and effective medicines management, optimising the use of medicines by providing a high quality and friendly service. We do this by providing:

We have an in house pharmacy in the Norfolk, Great Yarmouth and Waveney part of the Trust, whilst in Suffolk, pharmacy supply services are provided by Ipswich and West Suffolk Hospital. Pharmacy contact details:

General enquiries
Telephone: 01603-421212

Hellesdon Hospital
Pharmacy department: 01603-421212
Medicines Information Helpline call 01603-421212 (12noon to 4.00pm)

Ipswich Hospital
Woodlands unit: 01473-891700
Medicines Information call Mon-Fri 01473-329141 [please leave a message and we will ring you back] or e-mail medicines.info@nsft.nhs.uk

West Suffolk Hospital
Wedgwood unit: 01284-719700

Questions, comments or complaints about the pharmacy service
Esther Johnston,
Chief Pharmacist,
St. Clement's Hospital,
Foxhall Road,
Ipswich IP3 8LS
esther.johnston@nsft.nhs.uk