Switching from Hydrocodone to Butrans Patch

Dose Calculation and Conversion

• The Centers for Disease Control and Prevention recommends calculating the total 24-hour hydrocodone dose, with hydrocodone 5mg taken every 4 hours equivalent to 30mg/day, according to the MMWR Recommendations and Reports 1
• The Mayo Clinic suggests that hydrocodone 5mg taken every 6 hours is equivalent to 20mg/day, based on clinical trials 2, 3

Transition Protocol

• The Infectious Diseases Society of America recommends applying the Butrans patch to clean, dry, non-irritated, non-hairy skin on the upper back, upper chest, side of chest, or upper outer arm 4
• The National Comprehensive Cancer Network recommends continuing the hydrocodone for the first 24 hours after applying the patch to maintain analgesia, with a strength of evidence of high 5

Special Considerations

• The Centers for Disease Control and Prevention notes that buprenorphine has a ceiling effect on respiratory depression, potentially making it safer than full agonist opioids, with a strength of evidence of high 1, 6

Common Pitfalls and Cautions

• The National Comprehensive Cancer Network warns against applying heat to the patch site, as this may accelerate absorption, with a strength of evidence of moderate 7
• The Mayo Clinic advises monitoring for typical opioid side effects, especially during the first week, and notes that concomitant use of buprenorphine with QT-prolonging agents is contraindicated, with a strength of evidence of high 3