Emily asked
Why did my doctor prescribe me oxycodone IR (10 mg) with Butrans patch (buprenorphine patch) if buprenorphine blocks the oxycodone?
At a glance
- The active ingredient in Butrans is buprenorphine, which is a partial opioid agonist.
- Buprenorphine has a lower risk of abuse and addiction than other opioid medications, because it has a ceiling effect where its effects plateau after a certain dose.
- Oxycodone is a full opioid agonist and has no ceiling effect. Oxycodone may therefore be used to help reduce pain that is uncontrolled by Butrans.
Answer
While it is definitely not common to be on both of these medications at the same time, there is some emerging preclinical evidence that buprenorphine and other opioids might produce synergy when used together.
Any benefits derived from this combination must be weighed against the risks associated with using multiple opioids at the same time, such as the increased risk of respiratory depression.
Butrans (buprenorphine transdermal system) is FDA approved for the management of severe pain requiring daily, around the clock, long-term treatment with opioids.
Buprenorphine is a partial opioid agonist. This means that buprenorphine binds to opioid receptors, but does not produce as great of a response as a full agonist like morphine would.
While buprenorphine may delay other opioids from reaching opioid receptors, it doesn’t quite block the receptor completely as you said in your question. To block the opioid receptor completely would require an antagonist, like Narcan (naloxone).
Oxycodone IR is a full opioid agonist and is FDA approved for the management of moderate to severe pain.
Since Buprenorphine is a partial opioid agonist, increasing the dose of buprenorphine increases the effect, such as pain relief, but only to a certain extent.
The effects of buprenorphine eventually plateau and no longer increase with increasing doses. This is called the ceiling effect. This is why buprenorphine carries a lower risk of abuse and addiction compared to full opioid agonists.
So, to answer your question, your doctor is likely using Butrans for baseline pain control because it is safer (associated with fewer opioid-related risks like abuse and addiction) than using other opioid medications around the clock.
Your doctor is possibly then supplementing that regimen with 10 mg Oxycodone IR for breakthrough pain to provide you with further pain relief (when you need it) to overcome the ceiling effect of buprenorphine.
That is just my best guess at what your doctor is trying to do. If you want to know his/her thought process and why he/she is choosing this combination you should reach out to them and ask them this question.
References:
Butrans [package insert]. Stamford, CT: Purdue Pharma L.P.; 2019
Roxicodone [package insert]. Newport, KY: Xanodyne Pharmaceuticals, Inc.; 2006
