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A Case Report of End-of-Dosage Failure With Buprenorphine Patch
Samiddhi D Weerasiri1, Leslie R Siegel2, Regina M Mackey3
1Internal Medicine Resident (S.D.W.), Mayo Clinic, Rochester, Minnesota, USA.
Journal of Pain and Symptom Management
|January 30, 2026
Summary
This case report details the first instance of end-of-dosage failure with a buprenorphine patch. Patients experiencing a wearing-off effect may benefit from a shorter, five-day dosing interval for sustained pain relief.
Area of Science:
- Palliative Care
- Pain Management
- Oncology
Background:
- Effective pain management is crucial in palliative care.
- This report addresses end-of-dosage failure with buprenorphine patches, a novel finding.
- Current knowledge gaps exist regarding buprenorphine patch efficacy in all patients.
Purpose of the Study:
- To report the first case of end-of-dosage failure with a buprenorphine patch.
- To challenge the assumption of seven-day analgesic efficacy for buprenorphine patches.
- To highlight the need for individualized pain management strategies.
Main Methods:
- A case report of a 72-year-old male with metastatic adenocarcinoma.
- Patient transitioned from tramadol to a buprenorphine patch (5mcg/hr).
- Observed wearing-off effect by day five of buprenorphine patch treatment.
Main Results:
- The patient experienced consistent wearing-off of buprenorphine analgesic effect by day five.
- Exchanging the patch on day five resolved abdominal pain and improved quality of life.
- This case demonstrates end-of-dosage failure with buprenorphine patch therapy.
Conclusions:
- Buprenorphine patches may not provide seven-day analgesic efficacy for all patients.
- Screening for premature wearing-off of buprenorphine effect is recommended.
- A reduced five-day dosing interval may improve sustained analgesia for some patients.
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