Buprenorphine Injection (Pain Relief)

Buprenorphine injection may be habit-forming, especially with prolonged use. Use buprenorphine injection exactly as directed. Do not use more of it, use it more often, or use it in a different way than directed by your doctor. While you are using buprenorphine injection, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, has overused prescription medications, or has had an overdose, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse buprenorphine injection if you have or have ever had any of these conditions. Talk to your health care provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Buprenorphine injection may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to use buprenorphine injection. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), sleep apnea (condition in which the airway becomes blocked or narrow and breathing stops for short periods during sleep), a head injury, a brain tumor, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.

Taking certain medications during your treatment with buprenorphine injection may increase the risk that you will experience breathing problems or other serious, life threatening breathing problems, sedation, or coma. Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while using buprenorphine injection. Your doctor may need to change the dosages of your medications or monitor you carefully for side effects. If you use buprenorphine injection with other medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with buprenorphine injection increases the risk that you will experience serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment.

Tell your doctor if you are pregnant or plan to become pregnant. If you use buprenorphine injection regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight.

Talk to your doctor about the risk(s) of using buprenorphine injection.

Buprenorphine injection is used as a short-term treatment to relieve severe pain in people who are expected to need an opioid pain medication and who cannot be treated with other pain medications. Buprenorphine injection is in a class of medications called opiate partial agonists. It works by changing the way the body senses pain.

Buprenorphine injection comes as an solution (liquid) to be injected intramuscularly (into a muscle) or intravenously (into a vein) injection by a health care provider. It is usually given for severe pain every 4 to 6 hours, as needed.

Your doctor may adjust your dose of buprenorphine injection during your treatment, depending on how well your pain is controlled and on the side effects that you experience. Talk to your doctor about how you are feeling during your treatment with buprenorphine injection. If you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain while you are using buprenorphine injection, call your doctor. Do not use more of it or use it more often than prescribed by your doctor.

If you have used buprenorphine injection for longer than a few days, do not stop using it suddenly. If you suddenly stop using buprenorphine injection, you may experience withdrawal symptoms including restlessness; teary eyes; runny nose; yawning; sweating; chills; muscle, back or joint pain; widening of the pupils; irritability; anxiety; weakness; stomach cramps; difficulty falling asleep or staying asleep; nausea; loss of appetite; vomiting; diarrhea; fast breathing; or fast heartbeat. Your doctor will probably decrease your dose gradually.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using buprenorphine injection,

• tell your doctor and pharmacist if you are allergic to buprenorphine, any other medications, or any of the ingredients in buprenorphine injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), procarbazine (Matulane), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate).
• The following nonprescription or herbal products may interact with buprenorphine injection: St. John's wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using buprenorphine injection. Do not start these medications while using buprenorphine injection without discussing it with your healthcare provider.
• tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section, a blockage in your stomach or intestine, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you that you should not use buprenorphine injection.
• tell your doctor if you have or have ever had prolonged QT syndrome (condition that increases the risk of developing an irregular heartbeat that may cause loss of consciousness or sudden death);. low levels of potassium or magnesium in the blood; heart failure; a slow or irregular heartbeat; seizures; diabetes; adrenal problems such as Addison's disease (condition in which the adrenal gland produces less hormone than normal); benign prostatic hypertrophy (BPH, enlargement of the prostate gland); difficulty urinating; a curve in the spine that makes it hard to breathe; or thyroid, gallbladder, pancreas, kidney, or liver disease.
• tell your doctor if you are breastfeeding. You should not breastfeed while you are using buprenorphine injection. Tell your baby's doctor right away if your baby is sleepier than usual or has trouble breathing while you are using this medication.
• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using buprenorphine injection.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using buprenorphine injection.
• you should know that buprenorphine injection may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that buprenorphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• you should know that buprenorphine may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are using buprenorphine injection.

Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medication.

Buprenorphine injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• headache
• dizziness
• drowsiness
• sweating

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• rash; hives; itching; difficulty breathing or swallowing; or swelling of your face, throat, tongue, lips, or eyes
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, slurred speech, severe muscle stiffness or twitching, loss of coordination, or diarrhea
• nausea, vomiting, loss of appetite, weakness, or dizziness
• inability to get or keep an erection
• irregular menstruation
• decreased sexual desire
• narrowing or widening of the pupils (black circles in the center of the eye)
• seizure

Buprenorphine injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

While using buprenorphine injection, you should talk to your doctor about having a rescue medication called naloxone readily available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Symptoms of overdose may include the following:

• narrowing or widening of the pupils (black circles in the center of the eye)
• slowed, shallow, or difficulty breathing
• extreme sleepiness or drowsiness
• unable to respond or wake up
• coma (loss of consciousness for a period of time)
• cool, clammy, or blue skin
• limp or weak muscles
• slow heartbeat
• unusual snoring

Keep all appointments with your doctor and the laboratory.

Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are using buprenorphine injection.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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