# # Adverse effects as per other opioids # Constipation Nausea and vomiting # Anaphylaxis Severe itching # Sublingual tablets, 0.2–0.4 mg 6-8 hourly Topical preparations (Norspan® patches) multiple sizes, 5-40 mcg/hour changed weekly The smallest patch size (5 mcg/hr) is equivalent to about 10 mg oral morphine/day # Place the tablets under the tongue until dissolved (takes 2–10 minutes). Patches can be placed anywhere on the skin, usually the upper arms or chest. # Ensure the patch is adhering completely to the skin (analgesic effect is dependent on this). The full analgesic effect will not be felt for 12 hours and will persist for 12 hours post patch removal. It is possible to shower/bathe with the patch in situ. # Buprenorphine is a partial opioid receptor agonist (partial agonist effect does not occur at low doses commonly used). Safe in patients with renal impairment Usually well tolerated in the elderly. # Temgesic® 200 mcg sublingual tablets (non PBS) Norspan® transdermal patches 5, 10, 15, 20, 30, 40 mcg/hr