BELBUCA ® buccal film is indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

Limitations of Use

Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with long-acting opioid formulations, reserve BELBUCA ®  for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.

BELBUCA ®  is not indicated as an as-needed (prn) analgesic.


BELBUCA ®  is contraindicated in patients with significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment; known or suspected gastrointestinal obstruction, including paralytic ileus; and hypersensitivity (e.g., anaphylaxis) to buprenorphine.


BELBUCA ® Advantages

No pituitary depression so no Opioid Induced Endocrinopathy (All Class II narcotics cause decreased SEX hormones)

Limited respiratory depression (this is lost if taking benzo) Blocks Euphoria

Effective for neuropathic pain (often helps CRPS). Can help to eliminate need for gabapentin or Lyrica.

Only 3% Opioid Induced Constipation

Since BELBUCA ® is active at the mu receptors in the spinal cord and is NOT active in the brain, there is no cognitive or vestibular impairment.

OK to continue CII Immediate Release Opioid since BELBUCA ® is a kappa antagonist.

BELBUCA ® is 50-60% bioavailable. Butrans is only 13% bioavailable.

CAUTION: Nausea during the first week is common, especially if dose too high. Best way to minimize nausea is to start with one film daily for 3 days and then q 12 hours.

Peak effect in 3 hours.

It takes 3 days to build up to full effectiveness, therefore can titrate up every 3 days if needed.

Still requires standard block box warnings as for ALL narcotics. Refer to BELBUCA ® website for complete information