The starting dosage of the buprenorphine patch (Butrans) for chronic pain will be highly individualized. It will depend largely on the type and dose of the other opioids you have been taking.
After calculating the dosage of your other opioid medications, your healthcare provider will convert that to an initial Butrans dose. It is best to underestimate the amount initially in order to avoid potentially dangerous side effects. If you have not been taking other opioids, the standard starting amount is one Butrans 5 mcg/hour patch applied once a week.
Your healthcare provider may also recommend a short-acting pain medication to be used on an "as needed" basis, for when your pain is especially severe (sometimes called "breakthrough pain"). You may find you need more of the breakthrough pain medication when you first start using Butrans. This is because it can take several days for the full effects of the medication to be felt.
Because initial doses are often underestimated, many people find they will need an increase from the initial dose. If your pain is not adequately controlled after three days, your healthcare provider may increase your Butrans dosage. This increase will be based on the amount of short-acting pain medication you needed in the two to three days after starting Butrans.
The absolute maximum dosage for Butrans is one 20-mcg/hour patch applied once a week. Higher doses increase the risk of dangerous changes in the heart rhythm.