By Rania Gollakner, BS, DVM, MPH

What is buprenorphine?

Buprenorphine (brand names: Buprenex®, Simbadol®, Belbuca®, Vetergesic®, Buprenodale®, Sublocade®, Suboxone®, Subutex®, Temgesic®) is an opioid analgesic used to treat pain, or is used as a preanesthetic in the hospital or clinic setting.

Its use in dogs, small mammals, large animals, and sometimes cats to treat pain is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

How is buprenorphine given?

Buprenorphine is given by mouth in the form of a liquid. It should not be eaten, but rather it should be squirted into the side of the mouth into the cheek pouch or under the tongue so that it can be absorbed through the mouth. Measure liquid doses very carefully, as this is a potent drug. It can also be given by injection in the hospital or clinic setting. Occasionally, you may be asked to give injections of this medication under the skin at home; be sure to follow your veterinarian’s instructions carefully.

This medication will take effect quickly, in about 1 to 2 hours, and improvement in clinical signs should follow.

What if I miss giving my pet the medication?

Give the missed dose as soon as you remember, and then wait the recommended amount of time between doses. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

The most common side effect is sleepiness. Injections into the muscle may cause pain at the injection site. In dogs, agitation, low or high heart rate, vomiting, low body temperature, or high blood pressure may rarely occur. In cats, behavior changes, increased heart rate or body temperature, or vomiting is rare but may occur. Serious side effects are uncommon but can include severely decreased breathing rate. In horses and rabbits, slower gastrointestinal movements can occur.

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Buprenorphine should not be used in pets that are allergic to it or other opioids, or in pets being treated with amitraz (e.g., Mitaban®, certain flea collars). Buprenorphine should be used cautiously in pets with low thyroid levels, liver disease, bile disease, heart and/or lung disease, kidney disease, Addison’s disease, or in very young, very old, or debilitated pets. It should be used with extreme caution in pets with head trauma or other nervous system dysfunction. Use cautiously in pregnant or lactating animals, as the effects are not well established.

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with buprenorphine: local anesthetics, anticonvulsants, azole antifungals, benzodiazepines, cisapride, central nervous system depressant agents, cyclobenzaprine, desmopressin, erythromycin, fentanyl, halothane, metoclopramide, MAOIs (antidepressants), naloxone, pancuronium, phenobarbital, rifampin, serotonergic agents, or tramadol.

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this medication?

Your veterinarian may monitor your pet to be sure that the medication is working. Monitor your pet for adverse side effects, especially heart function and breathing.

How do I store buprenorphine?

Store at room temperature between 20°C and 25°C (68°F and 77°F) and protected from light, excessive heat above 40°C (104°F), and freezing. Follow the storage directions on the label for compounded forms of this medication.

Buprenorphine is a controlled substance, which means that it has been designated by the Drug Enforcement Administration (DEA) as having a potential for diversion to people other than the patient it was prescribed for. Use of a controlled substance in any person or animal other than that for which it is prescribed is illegal. Therefore, this medication should be stored in a locked cabinet or safe that cannot be easily moved, with access limited to only those that need to administer the medication. Monitor the amount of medication remaining to ensure the expected amount is present.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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