Butrans

[wscott]

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Hi,

A rep just stopped by and dropped off some material on Butrans. Anybody out there using it for their patients?

 

[lobelsteve]

I'm finding a 10mcg Butrans is equipotent to 10mg Lortab tid.

Pill popping behavior types hate it, others love it.

4 patches = 1 month.

Nice.

 

[mille125]

I'm finding a 10mcg Butrans is equipotent to 10mg Lortab tid.

Pill popping behavior types hate it, others love it.

4 patches = 1 month.

Nice.

0/30 in patients trying it and liking it...maybe i have a bunch of pill poppers

 

[jpb26]

I have tried maybe 10-15 pts on it with very good results so far. Honestly I was a bit skeptical at first but I cant argue with the results so far. I do agree of the pts who didnt like it most seemed to be seasoned pill poppers.

 

[Aether2000]

Works best in opioid naive patients that are not dependent on the euphoria of the pharmacodynamically inferior mu agonist hydrocodone to feel good. The irony is that in the US, the patches are limited to 20mcg/hour due to QT interval prolongation whereas Suboxone or Subutex that is typically administered at 8 to 32 times higher doses of burprenorphine, has no such warnings or limitations. It shows the ridiculous inconsistencies of the FDA in drug approvals and how the FDA brand of safety is really a myth.

 

[Gauss]

how do you get this paid for? Insurances won't pay for anything: nucynta denied, butrans denied, lyrica denied

 

[drusso]

I've had 3 cases of hypersensitivity reaction to the patches. However, agree with the general observations above. The other nice thing: It's not a schedule II medication.

 

[olafa]

I agree- the patients who want to try and aren't on higher doses do better. Like with suboxone seems that if they want it - rather that being forced to try it. They end up doing better. I like the idea of breaking the hand to mouth with the anxiety type patients. I have had pretty good sucess with the 10-15 or so anetdotally.

You cant really compare the doses of suboxone to butrans- the transdermal is going to much different to equate to an oral dose. Yeah it does seem like more, but exactly how much, not sure?? The patients who fail also may have started too low of dose. Then they just say it doesnt work and the tear it off. They say it takes 2-3days to reach steady state as well. Given that above 30mg Morphine equiv is for 10mcg patch- many more of our patients are above this. I have only use the 5mcg is one patient who was opioid naive.

Getting approval is usually with a denial letter explaining why you want to try this medication over any other.
Its tier three for most payors in our area.

Works best in opioid naive patients that are not dependent on the euphoria of the pharmacodynamically inferior mu agonist hydrocodone to feel good. The irony is that in the US, the patches are limited to 20mcg/hour due to QT interval prolongation whereas Suboxone or Subutex that is typically administered at 8 to 32 times higher doses of burprenorphine, has no such warnings or limitations. It shows the ridiculous inconsistencies of the FDA in drug approvals and how the FDA brand of safety is really a myth.