A Case Report of End-of-Dosage Failure With Buprenorphine Patch

Up-to-date knowledge of pain management strategies that provide analgesia and optimize function are central to the toolbox of palliative care and pain providers. To our knowledge, this is the first case report describing a patient with end-of-dosage failure with a buprenorphine patch.

A 72-year-old male with history of metastatic moderately differentiated adenocarcinoma of unknown primary is admitted to the hospital with cytopenia, abdominal pain and acute kidney injury (AKI) three weeks after administration of chemotherapy. The patient was transitioned from tramadol 50 mg as needed to buprenorphine patch 5 mcg/h two weeks prior to presentation but described a consistent wearing-off effect by day five of treatment. The patient's buprenorphine patch was exchanged on the evening of day five with resolution of his abdominal pain and improved quality of life markers such as sleep.

This case introduces the first instance in the literature describing end-of-dosage failure with buprenorphine patch and challenges the notion that buprenorphine patches provide seven days of analgesic efficacy for all patients. Ultimately, patients should be screened for premature wearing-off of buprenorphine effect and affected individuals may benefit from a reduced five-day dosing interval to provide more sustained analgesia.