Buprenorphine Buccal Films (Belbuca) for Pain

Buprenorphine Buccal Films (Belbuca) for Pain


Buprenorphine is an opioid medicine used to treat moderate to severe pain. It is a long acting pain medicine that may be prescribed by your health care provider if you have not had relief from other pain medicines. Buprenorphine comes in a buccal film (Belbuca) that is absorbed through the cheek to give pain relief to your whole body. This pain medicine is most often prescribed to be taken twice a day, with 12 hours between each dose. It may take 2 to 3 days before you notice pain relief. But, you may have some relief sooner. 

How to use the film

Before placing the film:

  • Wash your hands well with soap and water.
  • Make sure the film is in its package and not damaged in any way. 
  • Only remove the film when you are ready to use it. Do not cut or tear the film when you open the package or remove the film. 

Placing the film:

  • Wet the inside of your cheek with your tongue or water.
  • Put the film on the tip of your DRY finger, with the yellow side facing out (figure 1).
  • Place the yellow side of the film against the inside of your wet cheek. Do not place it too high or too far back in your cheek. Do not apply the film to areas of your mouth with any open sores or cuts. Hold the film in place for 5 seconds with your finger (figure 2). The film should then stay in place (figure 3).
  • Wash your hands well with soap and water after placing the film.
  • Keep the film in place until it dissolves fully — about 30 minutes. Do not swallow the medicine.
  • Do not chew, swallow, touch, or move the film after you put it on your cheek. 
  • Do not eat or drink until the film dissolves fully. Once dissolved, rinse your mouth with water and swallow. Wait 1 hour before brushing your teeth.
  • The film has a mild peppermint taste.
film on tip of index finger with yellow side facing out
figure 1

 

index finger holding film in place on inside of cheek
figure 2

 

film in place on inside of cheek
figure 3

 

Medicine side effects

This medicine is usually well tolerated. Some patients may:

  • Have nausea or vomiting
  • Have a dry mouth
  • Have constipation
  • Feel sleepy or drowsy
  • Feel lightheaded or dizzy

These side effects should improve over time, except for constipation. It is common for opioids to cause constipation that does not go away while on the medicine. Your provider may recommend that you take a laxative while on this medicine to help you have regular bowel movements.

Let your provider know if you have any of these rare, but serious, problems:

  • Slowed breathing
  • Signs of an allergic reaction, such as hives, itching, rash, or trouble breathing
  • Severe dizziness
  • Fainting
  • Hallucinations
  • Severe constipation where you are unable to have a bowel movement for several days or have stools that are hard and difficult to pass
  • Extremely low blood pressure
  • Dental problems, like cavities, infections, and loss of teeth have been reported with buprenorphine products that are dissolved in the mouth. This has happened even in people
    who did not already have dental problems. Call your provider and your dentist right away, if you have any problems with your teeth or gums.

If you or your loved one see your breathing is getting slower, do not take any more doses of the medicine, and call your provider or seek medical help right away.

It is important to tell your provider if you start taking any new medicines or if you stop taking a medicine, to make sure all your medicines can be safely taken together.

While using the films

  • Do not drive or operate heavy machinery until you know how the medicine affects you.
  • Avoid alcohol and products that contain alcohol to reduce the risk of overdosing.
  • Call 911 if your loved one has signs or symptoms of overdose, including:
    • Not breathing or less than 1 breath every 5 seconds
    • Pale and clammy skin
    • Lips, fingers, or toes look gray or blue in color
    • Heart beat or pulse is slow or has stopped
    • Snoring, gurgling, or choking sounds
    • Does not respond to shaking or rubbing your knuckles over breast bone in center of chest
  • See your dentist regularly for a dental exam to avoid problems, including tooth decay, cavities, oral infections, and loss of teeth.

How to store the films

  • Store the medicine at room temperature, away from heat, moisture, and direct light. Keep the film in its package until you are ready to use it.
  • Keep this medicine in a safe place out of the reach of children and pets. Do not share it with anyone. 

How to dispose of the films

It is important to dispose of medicine when it is no longer needed or has expired to keep the people and pets in your home safe.

There are several options to safely dispose of the films:

  • Flush them down the toilet. 
  • Mix them with coffee grounds or cat litter, and then throw them away in the trash. 
  • Look for a pharmacy, or a fire or police department that has drug take back events.

Frequently asked questions

What should I do if I miss a dose?

If you take this medicine for cancer-related pain and miss a dose, take the missed dose as soon as you remember. Your doses should be taken 12 hours apart. If it is within 6 hours of your next dose, skip the missed dose and take your next dose at the normal time. Do not double up on doses.

What should I do if I want to decrease or stop taking my opioid medicine?

It is important to talk to your provider before you decrease or stop taking this medicine. If you stop taking this medicine too quickly, you may have symptoms of opioid withdrawal. Your provider will work with you to create a plan to lower your dose, or to help you stop taking opioids.

Long-term pain management

If the use of this medicine is planned for your pain management, your provider may offer naloxone (Narcan). Naloxone is used to reverse the effects of opioids in the event of an accidental overdose or if too much medicine was taken. Naloxone is available in Ohio without a prescription, including at The Ohio State University Outpatient Pharmacy locations. The pharmacy can provide training to you and your family on how to use this nasal spray. For more information about the use of naloxone, talk to your provider.

© 2021 – March 16, 2022, The Ohio State University Wexner Medical Center

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care. For more health information, call the Library for Health Information at 614-293-3707 or email: health-info@osu.edu.