Please wait while the formulary information is being retrieved.
BELBUCA (BUPRENORPHINE HCL)
- Chronic pain
- Severe pain
150 mcg buccal film
- Place 1 film (150 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
300 mcg buccal film
- Place 1 film (300 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
450 mcg buccal film
- Place 1 film (450 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
600 mcg buccal film
- Place 1 film (600 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
75 mcg buccal film
- Place 1 film (75 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
750 mcg buccal film
- Place 1 film (750 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
900 mcg buccal film
- Place 1 film (900 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
Chronic pain
- Place 1 film (75 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route once daily
- Place 1 film (75 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (150 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (300 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (450 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (600 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (750 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (900 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
Severe pain
- Place 1 film (75 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route once daily
- Place 1 film (75 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (150 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (300 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (450 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (600 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (750 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Place 1 film (900 mcg) against the inside of the cheek, holding in place for 5 seconds, by buccal route 2 times per day
- Depade
- naltrexone
- naltrexone microspheres
- Revia
- Vivitrol
Contraindicated
- amiodarone
- amiodarone in dextrose,iso-osm
- Betapace
- Betapace Af
- Cordarone
- Corvert
- dextromethorphan-quinidine
- disopyramide
- dofetilide
- ibutilide fumarate
- Nexterone
- Norpace
- Norpace Cr
- Nuedexta
- Pacerone
- procainamide
- quinidine gluconate
- quinidine sulfate
- sodium oxybate
- Sorine
- sotalol
- Sotalol Af
- Tikosyn
- Xyrem
Severe
Moderate
- acetaminophen-codeine
- Alfenta
- alfentanil
- alprazolam
- Alprazolam Intensol
- amitriptyline-chlordiazepoxide
- Ascomp With Codeine
- Astramorph-pf
- Ativan
- belladonna alkaloids-opium
- Belladonna-opium
- bromphen-pseudoephed-codeine
- brompheniramine-PE-codeine
- Butalbital Compound W/codeine
- Butalbital Compound-codeine
- butalbital-acetaminop-caf-cod
- butorphanol tartrate
- Capcof
- Capital With Codeine
- carisoprodol-ASA-codeine
- Cheratussin Ac
- Cheratussin Dac
- chlorcyclizine-codeine
- chlordiazepoxide HCl
- chlordiazepoxide-clidinium
- chlorphen-pseudoephed-codeine
- chlorpheniramine-codeine
- chlorpheniramine-hydrocodone
- chlorpheniramine-PE-codeine
- clobazam
- clonazepam
- clorazepate dipotassium
- clrcycliz-pseudoephed-codeine
- codeine sulfate
- codeine-butalbital-ASA-caff
- codeine-guaifenesin
- codeine-pyrilamine
- cpm-pseudoephed-hydrocodone
- Demerol
- Demerol (pf)
- Depodur (pf)
- dexbrompheniramine-PSE-codeine
- dexchlorphen-phenyleph-codeine
- Diastat
- Diastat Acudial
- diazepam
- Diazepam Intensol
- dihydrocodeine-aspirin-caff
- Dilaudid
- Dilaudid (pf)
- diphenoxylate-atropine
- Doral
- Duramorph (pf)
- Endocet
- Endodan
- estazolam
- Fanatrex
- fentanyl citrate (PF)
- Fioricet With Codeine
- Fiorinal-codeine #3
- flurazepam
- gabapentin
- gabapentin enacarbil
- Gralise
- Gralise 30-day Starter Pack
- Guaiatussin Ac
- Guaifenesin Ac
- Guaifenesin Dac
- Guiatuss Ac
- Horizant
- Hycet
- hydrocodone bitartrate
- Hydrocodone Compound
- hydrocodone-acetaminophen
- hydrocodone-homatropine
- hydrocodone-ibuprofen
- Hydromet
- hydromorphone
- hydromorphone (PF)
- Ibudone
- ibuprofen-oxycodone
- Iophen C-nr
- isoniazid-rifamp-pyrazinamide
- Klonopin
- Librax (with Clidinium)
- Lomotil
- lorazepam
- Lorazepam Intensol
- Lortab Elixir
- Lortuss Ex
- M-clear Wc
- M-end Max D
- M-end Pe
- Mar-cof Bp
- Mar-cof Cg
- meperidine
- meperidine (PF)
- Meperitab
- midazolam
- morphine
- morphine (PF)
- morphine liposomal (PF)
- nalbuphine
- Neurontin
- Niravam
- Norco
- Onfi
- Opana
- opium tincture
- oxazepam
- Oxecta
- oxycodone
- oxycodone-acetaminophen
- oxycodone-aspirin
- oxymorphone
- paregoric
- pentazocine lactate
- pentazocine-naloxone
- Percocet
- Percodan
- Phenylhistine
- Phenylhistine Dh
- Poly-tussin
- Poly-tussin Ac
- Poly-tussin D
- Primlev
- Pro-clear Ac
- Pro-clear Caps
- Pro-red Ac (w/ Dexchlorphenir)
- Promethazine Vc-codeine
- promethazine-codeine
- promethazine-phenyleph-codeine
- pseudoephedrine-codeine-GG
- pseudoephedrine-hydrocodone
- quazepam
- Relcof C
- remifentanil
- Reprexain
- Restoril
- Rezira
- Rifadin
- Rifamate
- rifampin
- rifampin-isoniazid
- Rifater
- Roxicet
- Rydex
- Statuss Green (codeine)
- Sublimaze (pf)
- Sufenta
- sufentanil citrate
- Synalgos-dc
- Talwin
- temazepam
- Tranxene T-tab
- triazolam
- Trymine Cg
- Tusnel C
- Tussicaps
- Tussigon
- Tussionex Pennkinetic Er
- Tylenol-codeine #3
- Tylenol-codeine #4
- Ultiva
- Valium
- Vicodin
- Vicodin Es
- Vicodin Hp
- Vicoprofen
- Virtussin Ac
- Vituz
- Xanax
- Xanax Xr
- Xartemis Xr
- Xodol 10/300
- Xodol 5/300
- Xodol 7.5/300
- Z-tuss Ac
- Z-tuss E
- Zamicet
- Zodryl Ac 25
- Zodryl Ac 30
- Zodryl Ac 35
- Zodryl Ac 40
- Zodryl Ac 50
- Zodryl Ac 60
- Zodryl Ac 80
- Zodryl Dac 25
- Zodryl Dac 30
- Zodryl Dac 35
- Zodryl Dac 40
- Zodryl Dac 50
- Zodryl Dac 60
- Zodryl Dac 80
- Zodryl Dec 25
- Zodryl Dec 30
- Zodryl Dec 35
- Zodryl Dec 40
- Zodryl Dec 50
- Zodryl Dec 60
- Zodryl Dec 80
- Zohydro Er
- Zutripro
- Acute asthma attack
- Congenital long QT syndrome
- Paralytic ileus
Contraindicated
- Alcohol intoxication
- Drug abuse
- History of opioid overdose
- Intracranial hypertension
- Respiratory depression
- Severe hepatic disease
Severe
Moderate
- Adrenal cortical insufficiency
- Alcohol withdrawal delirium
- Benign prostatic hyperplasia
- Biliary tract disorder
- Chronic obstructive pulmonary disease
- Cor pulmonale
- Debilitation
- Untreated hypothyroidism
- Urethral stricture
BELBUCA (BUPRENORPHINE HCL)
- Chronic pain
- Severe pain
- Depression
- Infection
- Back pain
- Constipation
- Erythema of mucous membrane of mouth
- Headache disorder
- Hyperhidrosis
- Insomnia
- Nausea
- Oral hypoesthesia
- Pain
- Peripheral edema
- Sore tongue
- Symptoms of anxiety
- Vomiting
More Frequent
Severe
Less Severe
- Abscess
- CNS depression
- Respiratory depression
- Acute abdominal pain
- Chills
- Cough
- Diarrhea
- Dizziness
- Drowsy
- Dyspepsia
- Eye tearing
- Fever
- Flu-like symptoms
- General weakness
- Nervousness
- Pharyngitis
- Rhinitis
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Abnormal hepatic function tests
- Adrenal cortical insufficiency
- Anaphylaxis
- Androgen deficiency
- Hepatic failure
- Hepatitis
- Hepatorenal syndrome
- Hypersensitivity drug reaction
- Jaundice
- Sleep apnea
Less Severe
- Erectile dysfunction
- Infertility
- Libido changes
- Orthostatic hypotension
- Vasodilation of blood vessels
Contraindicated
None
Severe Precaution
Buprenorphine (SL,Misc)
Risk of respiratory depression. Sublingual, buccal and implant dose forms not recommended age <16 years.
- 1 Day – 16 Years
- Risk of respiratory depression. Sublingual, buccal and implant dose forms not recommended age <16 years.
Management or Monitoring Precaution
None
Buprenorphine
- Severity Level:
2
- Additional Notes: Neonatal withdrawal/resp.depress. w/chronic or high dose
Contraindicated
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Precaution Exists
Buprenorphine
Low levels in breastmilk; poor oral bioavail in infants; monitor for cns dep
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Drug shown to have adverse effect | Low levels in breastmilk; poor oral bioavail in infants; monitor for cns dep |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Buprenorphine
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for confusion, delirium and falls. Avoid treatment with 3 or more CNS active agents. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | Y | Y | Y | Y | Y | N |
BEERS: Y HEDIS: N STOPP: Y
No Known Risk
None
- Buprenorphine has a risk for abuse and addiction, which can lead to overdose and death. Buprenorphine may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you use the smallest dose of buprenorphine that works, and use it for the shortest possible time.<br /><br />See also How to Use section for more information about addiction. The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you use the wrong dose/strength. Using this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.<br /><br />Be sure you know how to use buprenorphine and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.<br /><br /> Do not chew or swallow the film. Also, do not inject the medication in the film. Chewing or swallowing the film or injecting the buprenorphine in the film may cause a fatal overdose.<br /><br /> Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows or uses this drug, get medical help right away. Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits.<br /><br />Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy.<br /><br />Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, use the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
| Chronic pain | |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| Severe pain | |
| G89 | Pain, not elsewhere classified |
| G89.1 | Acute pain, not elsewhere classified |
| G89.11 | Acute pain due to trauma |
| G89.12 | Acute post-thoracotomy pain |
| G89.18 | Other acute postprocedural pain |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| M25.5 | Pain in joint |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.52 | Pain in elbow |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.53 | Pain in wrist |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.54 | Pain in joints of hand |
| M25.541 | Pain in joints of right hand |
| M25.542 | Pain in joints of left hand |
| M25.549 | Pain in joints of unspecified hand |
| M25.55 | Pain in hip |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.56 | Pain in knee |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.57 | Pain in ankle and joints of foot |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M26.62 | Arthralgia of temporomandibular joint |
| M54.5 | Low back pain |
| M54.6 | Pain in thoracic spine |
| M79.6 | Pain in limb, hand, foot, fingers and toes |
| M79.60 | Pain in limb, unspecified |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.62 | Pain in upper arm |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.63 | Pain in forearm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.64 | Pain in hand and fingers |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.65 | Pain in thigh |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.66 | Pain in lower leg |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.67 | Pain in foot and toes |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R07.82 | Intercostal pain |
| R10.0 | Acute abdomen |
| R10.1 | Pain localized to upper abdomen |
| R10.10 | Upper abdominal pain, unspecified |
| R10.11 | Right upper quadrant pain |
| R10.12 | Left upper quadrant pain |
| R10.2 | Pelvic and perineal pain |
| R10.3 | Pain localized to other parts of lower abdomen |
| R10.30 | Lower abdominal pain, unspecified |
| R10.31 | Right lower quadrant pain |
| R10.32 | Left lower quadrant pain |
| R10.33 | Periumbilical pain |
| R10.8 | Other abdominal pain |
| R10.84 | Generalized abdominal pain |
| R10.9 | Unspecified abdominal pain |
| R52 | Pain, unspecified |
| R68.84 | Jaw pain |
| 0-9 | A-Z |
|---|---|
| G89 | Pain, not elsewhere classified |
| G89.1 | Acute pain, not elsewhere classified |
| G89.11 | Acute pain due to trauma |
| G89.12 | Acute post-thoracotomy pain |
| G89.18 | Other acute postprocedural pain |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| M25.5 | Pain in joint |
| M25.50 | Pain in unspecified joint |
| M25.51 | Pain in shoulder |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.52 | Pain in elbow |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.529 | Pain in unspecified elbow |
| M25.53 | Pain in wrist |
| M25.531 | Pain in right wrist |
| M25.532 | Pain in left wrist |
| M25.539 | Pain in unspecified wrist |
| M25.54 | Pain in joints of hand |
| M25.541 | Pain in joints of right hand |
| M25.542 | Pain in joints of left hand |
| M25.549 | Pain in joints of unspecified hand |
| M25.55 | Pain in hip |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.559 | Pain in unspecified hip |
| M25.56 | Pain in knee |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.57 | Pain in ankle and joints of foot |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M26.62 | Arthralgia of temporomandibular joint |
| M54.5 | Low back pain |
| M54.6 | Pain in thoracic spine |
| M79.6 | Pain in limb, hand, foot, fingers and toes |
| M79.60 | Pain in limb, unspecified |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.603 | Pain in arm, unspecified |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.606 | Pain in leg, unspecified |
| M79.609 | Pain in unspecified limb |
| M79.62 | Pain in upper arm |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.629 | Pain in unspecified upper arm |
| M79.63 | Pain in forearm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.639 | Pain in unspecified forearm |
| M79.64 | Pain in hand and fingers |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.643 | Pain in unspecified hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.646 | Pain in unspecified finger(s) |
| M79.65 | Pain in thigh |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.659 | Pain in unspecified thigh |
| M79.66 | Pain in lower leg |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.669 | Pain in unspecified lower leg |
| M79.67 | Pain in foot and toes |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.673 | Pain in unspecified foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
| M79.676 | Pain in unspecified toe(s) |
| R07.82 | Intercostal pain |
| R10.0 | Acute abdomen |
| R10.1 | Pain localized to upper abdomen |
| R10.10 | Upper abdominal pain, unspecified |
| R10.11 | Right upper quadrant pain |
| R10.12 | Left upper quadrant pain |
| R10.2 | Pelvic and perineal pain |
| R10.3 | Pain localized to other parts of lower abdomen |
| R10.30 | Lower abdominal pain, unspecified |
| R10.31 | Right lower quadrant pain |
| R10.32 | Left lower quadrant pain |
| R10.33 | Periumbilical pain |
| R10.8 | Other abdominal pain |
| R10.84 | Generalized abdominal pain |
| R10.9 | Unspecified abdominal pain |
| R52 | Pain, unspecified |
| R68.84 | Jaw pain |
Formulary Reference Tool