Buprenorphine transdermal patch induced intractable vomiting in a low backache patient. Are unmonitored patches safe?

Buprenorphine transdermal patches (TPs) are used for the management of both acute and chronic pain of varied aetiologies. They offer a convenient and sustained method of drug delivery with a good safety profile. Though nausea and/or vomiting have been reported with buprenorphine TP, intractable vomiting (without spontaneous resolution) has never been reported before. We report a 45-year-old female who presented with acute exacerbation of chronic low back pain with radiculopathy of bilateral lower limbs. We offered her conservative management initially. Buprenorphine TP (10 mcg/hour) was applied along with the prescription of a few oral medications. However, the subsequent day, she visited our clinic again with complaints of 6-7 episodes of vomiting with persistent nausea over the past 24 hours. Buprenorphine TP-induced vomiting was suspected. The patch was removed promptly, and rescue antiemetics were administered. Monitoring of patients on opioids, even with TPs, is warranted.