Buprenorphine (Intradermal)

If you suffer severe pain and need constant pain relief over an extended period, your doctor might prescribe a buprenorphine transdermal skin patch.

Overview

Known in the US by its brand name Butrans, Buprenorphine transdermal is a skin patch that treats chronic pain when you need 24-hour pain relief over weeks or months. It's part of a family of medicines known as narcotic analgesics (pain medicines). This medication impacts your central nervous system to alleviate pain.

It's not recommended that you utilize the buprenorphine skin patch for pain medicine if you only need it for a short time, such as the case when you are recovering from surgery. Also, avoid it if your pain is mild, and you are instructed to use pain medicines on an "as needed"basis.

Using a narcotic for a long time leaves you prone to habit-forming behavior, which in turn causes a physical and mental dependence on the drug. On the other hand, if you suffer chronic pain, you shouldn't let the fear of addiction alone prevent you from seeking relief through narcotics. Mental dependence is also called addiction and is unlikely if you use narcotics only to prevent pain. Physical dependence can lead to withdrawal when you suddenly stop taking the medicine. Severe withdrawal is preventable if you gradually reduce the dosage over time.

Buprenorphine transdermal can only be obtained via a prescription from your doctor, and they will prescribe when and how to use the skin patch for your pain. You may find that your doctor will change the instructions several times to determine what is working to reduce the pain. Ty to follow instructions methodically to ensure the best chance of success.

Buprenorphine transdermal, like all prescription medication, comes with a medication guide and instructions for usage. For best results, carefully read all instructions and information provided. If you don't get the guide or instructions when you receive the patch, contact your health care professional prior to using the patch.

When you wear the skin patch, your doctor should provide exact instructions that are easy to understand. You won't get the intended relief if the patch isn't applied correctly. Only put it on skin that is not damaged or irritated. Keep the patch away from your mouth and do not chew on or swallow it.

Buprenorphine transdermal patches come in several sealed pouches. Avoid any medicine where the pouch seal has been broken. If the pouch is damaged or modified in any way, don't use it. Do not remove the patch from the sealed pouch until you are ready to apply it.

To accommodate different requirements and tolerances, it comes in three dosage strengths and associated sizes. Verify the size and strength against the prescription before using the patch.

When you hold the patch, avoid the sticky portion, which is the adhesive needed to adhere the medicine patch to your skin. Also, since this part also contains some medicine, you don't want it to come in contact with your hand, which will absorb the buprenorphine too quickly. If any of the medication somehow gets on your hands, wash it off immediately with water. Don't use soap or anything else until you're sure the medicine is gone.

Note that holes or tears to the patch compromise the dosage. Because it's damaged, it could let buprenorphine seep into your body through your skin too quickly, resulting in an overdose.

Put the patch on skin that is dry, in a flat area of the chest, back, side of the chest or upper arm. Don't put it on oily skin, or in places with scar tissue, burns, cuts or irritations. For best results, find an area with little or no hair. If you shave the area, make sure the skin isn't irritated when you apply the patch. Instead, try to clip the hair in the area short.

If you are going to clean the skin before applying the patch, use water with no soap. Don't put lotion or any kind of oil or alcohol on the area where the medicine will go. In fact, the skin needs to be absolutely dry.

Take off the lining that covers the sticky side and press down on the patch until it's securely in place. You can use the palm of your hand and press down for at least 15 seconds. Check the edges until you are satisfied that the entire patch has adhered to your skin. However, don't rub the patch or you will rub excess medicine into the skin. If you have a problem with the patch getting loose, use first aid tape along the edges to keep it in place.

If your patch falls off, don't reapply it. Throw it away and put on a new one in another area of your body. After seven days, you should manually remove the patch if it is still intact, unless otherwise directed by your doctor. Don't apply the patch in the same place when you change it. Try to use the opposite side of your body. It's better to wait at least 21 days before re-applying a patch to the same area.

Condition treated?

  • Chronic pain

Type of medicine?

  • Narcotic analgesics (pain medicines)

Side Effects

The following section discusses possible side effects with this medicine. Not all people experience side effects. Some people may experience side effects not listed here since every case is unique. These side effects may require medical care.

Check with your doctor if you experience the following more common side effects:

  • rapid weight loss/gain
  • Bloating in hands, face, arms, feet, or lower legs
  • tingling in hands or feet
  • swelling or blisters at patch site

Less common:

  • general feeling of discomfort or illness
  • increased sweating
  • nausea
  • fever
  • sweating
  • lower back or side pain
  • nasal congestion
  • pounding in the ears
  • Bladder pain
  • loss of voice
  • chest pain
  • shivering
  • bloody or cloudy urine
  • diarrhea
  • difficult or labored breathing
  • joint pain
  • slow or fast heartbeat
  • nervousness
  • muscle stiffness
  • tightness in the chest
  • burning, crawling, prickling, itching, numbness or "pins and needles" feelings
  • dizziness
  • difficulty with moving
  • difficult, burning, or painful urination
  • shakiness in the hand, arms, legs or feet
  • frequent urge to urinate
  • unusual tiredness or weakness
  • loss of appetite
  • trouble sleeping
  • blurred vision
  • muscle aches and pains
  • vomiting
  • trembling or shaking of the hands or feet
  • headache
  • pain in the arms or legs
  • chills
  • sore throat
  • pain
  • body aches or pain
  • ear congestion
  • cough producing mucus
  • runny nose
  • sneezing

Rare side effects:

  • umbness in the extremities: feet, hand and mouth
  • dry mouth
  • arm, back, or jaw pain
  • body aches or pain
  • hive-like swelling on the eyelids, face, lips, legs, feet, hands, tongue, throat or sex organs
  • loss of bladder control
  • fast, irregular, pounding, or racing heartbeat or pulse
  • sweating
  • difficulty swallowing or extremely shallow or slow breathing
  • confusion accompanied by any other symptoms
  • blistering, dryness, burning, or flaking skin
  • trembling or shaking of the hands or feet
  • sunken eyes
  • Abdominal or stomach pain or tenderness
  • flushing, red skin on the face and neck
  • dizziness, faintness, or lightheaded feeling when you get up suddenly from a lying or sitting position
  • chest tightness or heaviness
  • rapid breathing or irregular, fast or slow, or shallow breathing
  • thirstiness
  • wrinkled skin
  • pain
  • blue lips, fingernails, or skin
  • runny nose
  • trouble with walking
  • swelling or puffiness of the face
  • itching, scaling, soreness, severe redness, or swelling anywhere on your skin
  • decreased urination
  • feeling of warmth or heat
  • ear congestion
  • sneezing
  • deep or fast breathing with dizziness
  • pain in the arms or legs
  • chills
  • cough producing mucus or sore throat
  • headache
  • slow or irregular heartbeat
  • loss of consciousness or any lightheaded feeling, dizziness, or fainting
  • increase in heart rate

If you experience any of the following symptoms after you apply the patch, seek emergency medical help:

Symptoms of overdose

  • weak muscle tone
  • sleepiness or unusual drowsiness
  • pale or blue lips, fingernails, or skin
  • slow heartbeat
  • very slow or troubled breathing
  • cold and clammy skin
  • convulsions (seizures)
  • unable to speak
  • pinpoint (small) pupils in the eyes
  • change in consciousness

Some side effects may be uncomfortable without requiring medical help. They typically go away when your body acclimates to the buprenorphine. Ask your doctor for advice on how to minimize these side effects. If any of these symptoms worsen or don't go away, tell your health care professional immediately:

More common side effects as a result of beginning to use the medicine:

  • Constipation
  • redness or rash where you place the patch site

Less common side effects as a result of beginning to use the medicine:

  • heartburn
  • anxiety
  • irritation at the patch site
  • upset or painful stomach
  • lack or loss of strength
  • back pain
  • muscle spasms
  • belching
  • acid or sour stomach
  • depression
  • indigestion
  • itching skin
  • swelling of the joints
  • eye/cheekbone pain or tenderness
  • severe headache
  • neck pain
  • rash
  • weight loss

Rare side effects as a result of beginning to use the medicine:

  • confusion about identity, place, and time
  • sensation of spinning
  • excess air or gas in the stomach or intestines
  • change in taste
  • loss of sexual ability, desire, drive, or performance
  • dry eyes or skin
  • tunnel vision
  • passing gas
  • swelling of the abdominal or stomach area
  • decreased weight
  • relaxed and calm
  • general feeling of discomfort or illness
  • being forgetful
  • halos around lights
  • cramps
  • blurred or loss of vision
  • changes in patterns and rhythms of speech
  • decreased interest in sexual intercourse
  • uncaring
  • inability to have or keep an erection
  • sleepiness
  • feeling of constant movement of self or surroundings
  • nightmares
  • slurred speech
  • muscle weakness
  • night blindness
  • double vision
  • heavy bleeding
  • pressure in the stomach
  • sense of detachment from self or body
  • distorted lights
  • full feeling
  • trouble with speaking
  • restlessness
  • disturbed color perception
  • lack of feeling or emotion
  • clumsiness or unsteadiness
  • agitation
  • loss of taste
  • feeling of unreality

You could have side effects that aren't listed here because no one else has yet reported them. If you experience anything unusual, call your health care professional for instructions. If you would like the FDA to track your symptoms, call them directly at 1-800-FDA-1088.

Dosage

  • Extended Release Transdermal patch

There is no "correct"dosage, since you may react differently to buprenorphine than other patients. The best thing to do is listen to your doctor and follow instructions carefully. For reference, we are providing the average dosage information for this medication. Do not be alarmed if your dosage varies widely from this information. Your doctor is the best person to ask any questions that you may have.

As with any medicine, strength determines the amount of medicine you should take. Since this is a transdermal skin patch, you won't have to think about taking it several times a day. Your doctor will determine how long it's safe and necessary for you to continue applying the patches.

For moderate to severe chronic pain:

Adults:

The dosage depends on whether you take other narcotics, and your doctor will determine the dosage. If you use other narcotics, your dosage will probably be much lower than those who aren't taking other narcotics. Each skin patch lasts seven days.

Children: Again, this varies from patient to patient, but will generally be much lower than for adults.

Missed Dose

If you forget to change or put on the patch, just put it on as soon as you remember. If it's close to the time when you should change the patch, just wait until then to apply a new one.

Interactions

Some medicines, when you use them together, cause adverse reactions. Unfortunately, prescribing them together. However, your doctor should consider whether to change any dosages due to possible negative outcomes.

While taking buprenorphine, note that the following drug can have a significantly adverse interaction with the transdermal patch. Avoid using:

  • Naltrexone

Other medicines have known interactions with some patients using the patch. It's recommended that you avoid the following if your doctor prescribes buprenorphine. It may not be possible to cut out these medications, but ask your doctor if it's safe to do so.

  • Acepromazine
  • Alfentanil
  • Ethopropazine
  • Fospropofol
  • Haloperidol
  • Aripiprazole
  • Dolasetron
  • Diazepam
  • Carbamazepine
  • Milnacipran
  • Ethylmorphine
  • Prochlorperazine
  • Nitrazepam
  • Melperone
  • Difenoxin
  • Zaleplon
  • Oxymorphone
  • Bromazepam
  • Oxycodone
  • Clorazepate
  • Pentobarbital
  • Lofepramine
  • Dihydrocodeine
  • Mesoridazine
  • Zolpidem
  • Palonosetron
  • Tryptophan
  • Nalmefene
  • Lithium
  • Olanzapine
  • Papaveretum
  • Methohexital
  • Doxepin
  • Benperidol
  • Fluvoxamine
  • Carbinoxamine
  • Trimeprazine
  • Eszopiclone
  • Amisulpride
  • Melitracen
  • Ramelteon
  • Paregoric
  • Promethazine
  • Lorcaserin
  • Granisetron
  • Propoxyphene
  • Levorphanol
  • Opipramol
  • Hydromorphone
  • Prazepam
  • Tizanidine
  • Lurasidone
  • Diphenhydramine
  • Isocarboxazid
  • Clonazepam
  • Topiramate
  • Thiothixene
  • Zotepine
  • Dichloralphenazone
  • Remoxipride
  • Enflurane
  • Trifluoperazine
  • Ziprasidone
  • Nitrous Oxide
  • Fluoxetine
  • Primidone
  • Meptazinol
  • Triazolam
  • Butorphanol
  • St John's Wort
  • Tianeptine
  • Nalorphine
  • Quetiapine
  • Temazepam
  • Pentazocine
  • Iloperidone
  • Selegiline
  • Bromopride
  • Flibanserin
  • Venlafaxine
  • Diacetylmorphine
  • Furazolidone
  • Moclobemide
  • Hydrocodone
  • Desvenlafaxine
  • Methylene Blue
  • Tranylcypromine
  • Nicomorphine
  • Rizatriptan
  • Paliperidone
  • Chloral Hydrate
  • Methocarbamol
  • Phenelzine
  • Protriptyline
  • Iproniazid
  • Clozapine
  • Amineptine
  • Promazine
  • Chlorzoxazone
  • Sibutramine
  • Pimavanserin
  • Flurazepam
  • Lorazepam
  • Methdilazine
  • Secobarbital
  • Ketazolam
  • Tilidine
  • Nortriptyline
  • Perampanel
  • Chlorpromazine
  • Perphenazine
  • Meclizine
  • Zolmitriptan
  • Chlorpheniramine
  • Perazine
  • Doxylamine
  • Methylnaltrexone
  • Tolonium Chloride
  • Nalbuphine
  • Metaxalone
  • Escitalopram
  • Midazolam
  • Thiopental
  • Alphaprodine
  • Amobarbital
  • Sertindole
  • Sertraline
  • Sufentanil
  • Naratriptan
  • Trifluperidol
  • Naloxone
  • Rasagiline
  • Carisoprodol
  • Samidorphan
  • Morphine Sulfate Liposome
  • Amitriptylinoxide
  • Sodium Oxybate
  • Orphenadrine
  • Diphenoxylate
  • Sulpiride
  • Tapentadol
  • Trimipramine
  • Mephobarbital
  • Duloxetine
  • Codeine
  • Flunitrazepam
  • Cariprazine
  • Ondansetron
  • Nefazodone
  • Atazanavir
  • Opium
  • Donepezil
  • Hydroxyzine
  • Fluspirilene
  • Alvimopan
  • Cocaine
  • Clomipramine
  • Hydroxytryptophan
  • Droperidol
  • Fentanyl
  • Periciazine
  • Halothane
  • Suvorexant
  • Pipotiazine
  • Mirtazapine
  • Piritramide
  • Morphine
  • Sumatriptan
  • Clobazam
  • Propofol
  • Vilazodone
  • Anileridine
  • Ketobemidone
  • Estazolam
  • Dibenzepin
  • Ketamine
  • Molindone
  • Opium Alkaloids
  • Paroxetine
  • Dexmedetomidine
  • Risperidone
  • Citalopram
  • Linezolid
  • Safinamide
  • Thiopropazate
  • Thioridazine
  • Imipramine
  • Isoflurane
  • Moricizine
  • Meperidine
  • Brompheniramine
  • Oxazepam
  • Methotrimeprazine
  • Nialamide
  • Alprazolam
  • Halazepam
  • Chlordiazepoxide
  • Frovatriptan
  • Dantrolene
  • Quazepam
  • Dextromethorphan
  • Methadone
  • Ethchlorvynol
  • Phenobarbital
  • Tramadol
  • Remifentanil
  • Baclofen
  • Dezocine
  • Vortioxetine
  • Amoxapine
  • Cyclobenzaprine
  • Eletriptan
  • Carphenazine
  • Asenapine
  • Fluphenazine
  • Hexobarbital
  • Thiethylperazine
  • Piperacetazine
  • Levomilnacipran
  • Pimozide
  • Desipramine
  • Butabarbital
  • Procarbazine
  • Triflupromazine
  • Zopiclone
  • Meprobamate
  • Buspirone
  • Almotriptan

Other Interactions

Some medication shouldn't be used when you plan to eat or drink certain food products. Using tobacco and alcohol while on any medication is not advised. Again, this is an individual thing and everyone can react differently or have no reaction at all. The following is not a complete listing but is based on reported interactions.

If you have to combine buprenorphine with the drug below, talk to your doctor about possible adverse effects.

  • Ethanol

In the end, it comes down to a personal choice, but it's better to know in advance that there is a risk.

Warnings

When you decide to take a drug that has been prescribed, research the good and bad results that you can experience from taking a drug. Your doctor should be your first resource for any concerns that you have. For the buprenorphine transdermal skin patch, think about the following:

Allergies

If you have unusual allergies or have had reactions to medicine in the past, let your doctor know prior to using buprenorphine. One other thing you should pass on in regard to allergies is whether you have allergies to preservatives, dyes, foods or animals. If you are taking any non-prescription medication, bring it to your doctor and read the label to discover whether to expect adverse reactions to the patch.

Pediatric

There isn't enough case study data based on the relationship between age and the effect of this medicine in children. Therefore, the efficacy of buprenorphine specific to the pediatric population is not known.

Geriatric

There isn't enough case study data based on the relationship between age and the effect of this medicine in older patients. Therefore, the efficacy of buprenorphine specific to the geriatric population is not known.

However, elderly patients are more likely to have constipation and difficulty urinating while using the transdermal patch. Age-related kidney, liver, lung and heart issues mean that greater caution should be used and care given to adjusting dosages as necessary for older patients using the patch.

Pregnancy

Information regarding buprenorphine transdermal route and pregnancy indicates that during all three trimesters, animal studies revealed negative effects. However, there are no studies conducted on pregnant women to corroborate these findings.

Breastfeeding

Buprenorphine has been linked to harmful effects on infants when taken by breastfeeding mothers. Therefore, it's recommended that you do not use the transdermal patch while breastfeeding. Alternative medicines should be sought out to avoid harming the infant.

Precautions

Make sure to check in with your doctor regularly while using this medicine to avoid negative outcomes. Your doctor should check that the medicine is having the intended positive outcome in reducing your pain. If you continue to use the transdermal patch, blood tests should be conducted periodically.

If you use narcotics for extended periods, you can expect severe constipation, which is very common. To counteract this, drink plenty of fluids, eat more fiber and ask your doctor to recommend a gentle laxative. It's important to try to limit constipation, which can cause other serious health risks.

It is not recommended that buprenorphine be taken during pregnancy. There are serious risks to the baby that may outweigh the benefits of using the patch. If you may be pregnant or are trying to become pregnant, ask your doctor for an alternative medication.

This medicine will magnify the impact of alcohol and other depressants. So, you may wish to avoid alcohol and any medicine that will make you drowsy.

This includes allergy and cold medications, sedatives, sleeping aids, tranquilizers and other narcotics. This category includes other prescription pain meds and some medications used for seizures. Avoid barbiturates, anesthetics, and muscle relaxers. This category includes some drugs used during dental procedures. Check with your dentist and doctor before mixing buprenorphine with any of the other medications.

Using the transdermal patch has been known to make patients confused, dizzy or disoriented so take precautions while wearing the patch. Check with your health care provider before you operate machinery, drive or conduct other activities that can be dangerous should you become dizzy.

When standing up, move slowly to avoid feeling faint, dizzy or lightheaded. This applies to rising from a sitting or lying position. Lie down if the feeling is overwhelming and it should pass.

Tell your doctor right away If you notice burning, itching or swelling at any of the application sites that you use throughout your treatment.

Taking this medicine can cause anaphylaxis, an allergic reaction that is potentially life-threatening. This requires emergency medical attention. To stay on top of this, keep your doctor's contact information with you and call the office if you notice hoarseness, a rash, itching, issues breathing or swallowing, or any swelling near your face or extremities.

Heat causes the buprenorphine to be absorbed from the patch into the body faster. There is a risk of side effects and overdoses. So, don't use a heating pad, heated water bed or sunlamp while wearing the transdermal patch. Avoid hot showers and long baths as well as direct sunlight. If you get a fever, seek medical attention.

After using this medicine for several days, don't stop without checking with your doctor. You might need to gradually decrease the treatment to avoid withdrawal symptoms. The side effects of stopping treatment cold include abdominal cramping, anxiety, fever, or restlessness.

If your patch comes off and sticks to another person, they should remove it and wash the area with water. It's a good idea for them to seek medical attention as well.

Abusing buprenorphine or another narcotic while taking buprenorphine can result in an overdose. If this happens, seek emergency medical help immediately. During a narcotic overdose, you may have trouble breathing, or you may stop breathing at all. Other results of an overdose include unconsciousness and death.

While overdosing, your breathing becomes very slow (less than 8 breaths per minute). Severe drowsiness ensues, even when someone is speaking to you. If you fall asleep, you might not be able to wake up. During an overdose, your skin is cold and clammy, your blood pressure plummets and your pupils dilate.

Other Medical Problems

If you have any other medical problems, the efficacy of buprenorphine could be compromised. Using the transdermal patch to take buprenorphine while suffering from any of the below conditions could have serious consequences. Be completely honest with your health care provider to avoid any risks to your health.

Be sure to tell your health care provider if you suffer any of the following:

  • Hypokalemia (low blood potassium)
  • Problems urinating
  • Central nervous system depression
  • Liver disease (such as hepatitis B or C)
  • Bradycardia (slow heartbeat)
  • Brain tumor
  • Stomach or bowel blockage
  • Seizures
  • Hypotension (low blood pressure)
  • Mental illness
  • Angina
  • Cor pulmonale (serious heart problem)
  • Heart disease
  • Hypothyroidism (an underactive thyroid)
  • Atrial fibrillation (abnormal heart rhythm)
  • Congestive heart failure
  • Alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Congenital long QT syndrome (aka, abnormal heart rhythm)
  • Drug dependence
  • Lung or breathing problems
  • Weakened physical condition
  • Pancreatitis
  • Gallbladder disease or gallstones
  • Sleep apnea
  • Heart rhythm problem
  • Head injury

Storage

The transdermal patch typically is worn for up to several days. However, you may still receive several patches between visits to your doctor. Store the extra patches in a sealed container kept away from moisture, heat and direct light. It's fine to store the patches at room temperature. Do not freeze the patches.

Make sure to store the buprenorphine someplace where children cannot get at them. If the medicine expires, discard it. Before you throw out the expired or unnecessary medicine, ask your doctor if there is a specific way to dispose of it.

Keep out of reach of pets in your home.

Buprenorphine causes unwanted side effects and can be fatal if consumed by pets, children or adults not used to strong narcotics. For this reason, you should take extra care to secure your patches in a place that isn't accessible to anymore who might purposely or accidentally use them.

When you get your kit for the patches, it should come with a disposal unit for used transdermal patches. Carefully read and follow the provided instructions printed on the disposal unit. Use one for each patch. Do not throw the patches directly into the trash. To use the unit, peel away the liner to expose the sticky adhesive. Attach the used patch to the glue on the disposal unit.

If you are disposing of an unused patch, take it from the pouch and take off the liner covering the sticky part of the patch. Attach the disposal unit and unused patch, seal the disposal unit and throw it in the trash. Your doctor or pharmacist can answer questions about the disposal unit. Make sure not to dispose of the liner in the toilet.

Summary

The buprenorphine patch (known as the Butrans) is approved for use in adults and children. It's used daily, around-the-clock and long-term. This opioid is used when no other options are sufficient.

Buprenorphine works to block mu-opioid receptors, which reduces pain. The patches come in five different strengths and dosage will be determined by a doctor depending on whether patients have ever used opioids before or are using other opioids along with the buprenorphine transdermal patch.

The adverse effects of the patch match the side effects of other opioids. These include dizziness, constipation, somnolence, vomiting and other symptoms. Your doctor should take extra care to make sure that you are aware of how to apply the patch, use it and dispose of it.

The patch is considered a Risk Evaluation and Mitigation Strategy (REMS) treatment plan. The patch slowly releases the pain reliever over a long time. By administering buprenorphine in this manner, the REMS is believed to reduce adverse side effects, including abuse and addiction. Patients receive a thorough guide as part of the prescription package, and it should be carefully reviewed and meticulously followed. Additionally, healthcare training is required to administer this medication.

Advantages include a convenient format to deliver the pain reliever buprenorphine that doesn't require remembering to take it several times a day. The dosing interval allows users to stick it once a week and then forget about it, whereas oral opioids are taken in several daily doses. Similar patches only last three days.

Additionally, a transdermal patch delivery system makes it possible for patients unable to swallow to receive pain relief. By wearing the patch for a week, you are able to better maintain blood levels. Oral medications have highs and lows that can be uncomfortable and a create a potential health risk.

If you are suffering from severe and constant pain and have digestive or other issues with other medicines, consider the patch to reduce your pain. It provides 24-hour relief without taking a single pill. Talk this over with your doctor and make sure you are clear on any medicines or health conditions that can impact your odds for a positive outcome. Be comfortable with the functionality of the patch before you seek it out.

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Last Reviewed:
December 22, 2017
Last Updated:
April 02, 2018
Content Source: