Buprenorphine/naloxone
Medically reviewed by Drugs.com. Last updated on Jan 13, 2022.
Commonly used brand name(s)
In the U.S.
- Cassipa
- Suboxone
- Zubsolv
Available Dosage Forms:
- Tablet
- Film
Therapeutic Class: Opioid Dependency
Pharmacologic Class: Opioid Agonist/Antagonist
Chemical Class: Opioid
Uses for buprenorphine/naloxone
Buprenorphine and naloxone sublingual tablet is used to treat opioid (narcotic) dependence or addiction. Buprenorphine and naloxone buccal film, sublingual film, or sublingual tablet is used for induction and maintenance treatment of opioid (narcotic) dependence. It should be used in patients who have already been treated with buprenorphine sublingual tablets.
When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence. Physical dependence may lead to withdrawal side effects if the narcotic is stopped suddenly. Severe withdrawal side effects can usually be prevented when a person is switched to buprenorphine and naloxone combination. It acts on the central nervous system (CNS) to help prevent the withdrawal side effects.
Buprenorphine/
Before using buprenorphine/naloxone
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For buprenorphine/
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to buprenorphine/
Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of buprenorphine and naloxone buccal film, sublingual film, or sublingual tablet in the pediatric population. Safety and efficacy have not been established.
Geriatric
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of buprenorphine and naloxone combination in the elderly. However, elderly patients are more likely to have age-related kidney, liver, heart, or lung problems, which may require caution and an adjustment in the dose for patients receiving buprenorphine and naloxone combination.
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking buprenorphine/
Using buprenorphine/
- Bepridil
- Cisapride
- Dronedarone
- Fluconazole
- Ketoconazole
- Levoketoconazole
- Mesoridazine
- Nalmefene
- Naltrexone
- Pimozide
- Piperaquine
- Posaconazole
- Safinamide
- Samidorphan
- Saquinavir
- Sparfloxacin
- Terfenadine
Using buprenorphine/
- Acecainide
- Acepromazine
- Alfentanil
- Alfuzosin
- Almotriptan
- Alprazolam
- Amineptine
- Amiodarone
- Amisulpride
- Amitriptyline
- Amitriptylinoxide
- Amobarbital
- Amoxapine
- Amphetamine
- Amprenavir
- Anagrelide
- Anileridine
- Apomorphine
- Aprepitant
- Aripiprazole
- Aripiprazole Lauroxil
- Armodafinil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Atazanavir
- Azithromycin
- Baclofen
- Bedaquiline
- Benperidol
- Benzhydrocodone
- Benzphetamine
- Boceprevir
- Bosentan
- Bromazepam
- Bromopride
- Brompheniramine
- Bupropion
- Buserelin
- Buspirone
- Butabarbital
- Butorphanol
- Calcium Oxybate
- Cannabidiol
- Carbamazepine
- Carbinoxamine
- Cariprazine
- Carisoprodol
- Carphenazine
- Ceritinib
- Cetirizine
- Chloral Hydrate
- Chlordiazepoxide
- Chloroquine
- Chlorpheniramine
- Chlorpromazine
- Chlorzoxazone
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clobazam
- Clofazimine
- Clomipramine
- Clonazepam
- Clopidogrel
- Clorazepate
- Clozapine
- Cobicistat
- Cocaine
- Codeine
- Conivaptan
- Crizotinib
- Cyclobenzaprine
- Cyclosporine
- Dabrafenib
- Dantrolene
- Daridorexant
- Darunavir
- Dasatinib
- Degarelix
- Delamanid
- Delavirdine
- Desipramine
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexamethasone
- Dexmedetomidine
- Dextroamphetamine
- Dextromethorphan
- Dezocine
- Diacetylmorphine
- Diazepam
- Dibenzepin
- Dichloralphenazone
- Difenoxin
- Diltiazem
- Diphenhydramine
- Diphenoxylate
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Doxylamine
- Droperidol
- Duloxetine
- Ebastine
- Efavirenz
- Eletriptan
- Encorafenib
- Enflurane
- Entrectinib
- Enzalutamide
- Eribulin
- Erythromycin
- Escitalopram
- Esketamine
- Eslicarbazepine Acetate
- Estazolam
- Eszopiclone
- Ethchlorvynol
- Ethopropazine
- Ethylmorphine
- Etravirine
- Famotidine
- Felbamate
- Fenfluramine
- Fentanyl
- Fexinidazole
- Fingolimod
- Flecainide
- Flibanserin
- Flunitrazepam
- Fluoxetine
- Fluphenazine
- Flurazepam
- Fluspirilene
- Fluvoxamine
- Formoterol
- Fosamprenavir
- Fosaprepitant
- Foscarnet
- Fosphenytoin
- Fospropofol
- Fostemsavir
- Frovatriptan
- Furazolidone
- Gabapentin
- Gabapentin Enacarbil
- Galantamine
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halazepam
- Halofantrine
- Haloperidol
- Halothane
- Hexobarbital
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroquinidine
- Hydroxychloroquine
- Hydroxytryptophan
- Hydroxyzine
- Ibutilide
- Idelalisib
- Iloperidone
- Imatinib
- Imipramine
- Indinavir
- Inotuzumab Ozogamicin
- Iproniazid
- Isocarboxazid
- Isoflurane
- Itraconazole
- Ivabradine
- Ivacaftor
- Ivosidenib
- Ketamine
- Ketazolam
- Ketobemidone
- Lapatinib
- Lasmiditan
- Lefamulin
- Lemborexant
- Lenvatinib
- Leuprolide
- Levocetirizine
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Linezolid
- Lisdexamfetamine
- Lithium
- Lofepramine
- Lofexidine
- Lomitapide
- Lopinavir
- Lorazepam
- Lorcaserin
- Loxapine
- Lumacaftor
- Lumefantrine
- Lurasidone
- Macimorelin
- Magnesium Oxybate
- Meclizine
- Mefloquine
- Melitracen
- Melperone
- Meperidine
- Mephobarbital
- Meprobamate
- Meptazinol
- Metaxalone
- Methadone
- Methamphetamine
- Methdilazine
- Methocarbamol
- Methohexital
- Methotrimeprazine
- Methylene Blue
- Metoclopramide
- Metronidazole
- Mibefradil
- Midazolam
- Mifepristone
- Milnacipran
- Mirtazapine
- Mitotane
- Mizolastine
- Mobocertinib
- Moclobemide
- Modafinil
- Molindone
- Moricizine
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nafarelin
- Nafcillin
- Nalbuphine
- Naldemedine
- Naloxegol
- Naratriptan
- Nefazodone
- Nelfinavir
- Nevirapine
- Nialamide
- Nicomorphine
- Nilotinib
- Nitrazepam
- Nitrous Oxide
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Ondansetron
- Opipramol
- Opium
- Opium Alkaloids
- Orphenadrine
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxazepam
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Ozanimod
- Pacritinib
- Palbociclib
- Paliperidone
- Palonosetron
- Panobinostat
- Papaveretum
- Paregoric
- Paroxetine
- Pasireotide
- Pazopanib
- Pentamidine
- Pentazocine
- Pentobarbital
- Perampanel
- Perazine
- Periciazine
- Perphenazine
- Phenelzine
- Phenobarbital
- Phenytoin
- Pimavanserin
- Pipamperone
- Piperacetazine
- Pipotiazine
- Piritramide
- Pitolisant
- Ponesimod
- Potassium Oxybate
- Prazepam
- Prednisone
- Pregabalin
- Primidone
- Probucol
- Procainamide
- Procarbazine
- Prochlorperazine
- Promazine
- Promethazine
- Propafenone
- Propofol
- Protriptyline
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Ramelteon
- Ranitidine
- Ranolazine
- Rasagiline
- Remifentanil
- Remimazolam
- Remoxipride
- Ribociclib
- Rifabutin
- Rifampin
- Rifapentine
- Risperidone
- Ritonavir
- Rizatriptan
- Ropeginterferon Alfa-2b-njft
- Scopolamine
- Secobarbital
- Selegiline
- Selpercatinib
- Sertindole
- Sertraline
- Sevoflurane
- Sibutramine
- Siponimod
- Sodium Oxybate
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- St John's Wort
- Sufentanil
- Sulpiride
- Sultopride
- Sumatriptan
- Sunitinib
- Suvorexant
- Tacrolimus
- Tamoxifen
- Tapentadol
- Telaprevir
- Telavancin
- Telithromycin
- Temazepam
- Tetrabenazine
- Thiethylperazine
- Thiopental
- Thiopropazate
- Thioridazine
- Thiothixene
- Tianeptine
- Tilidine
- Tizanidine
- Tolonium Chloride
- Tolterodine
- Topiramate
- Toremifene
- Tramadol
- Tranylcypromine
- Trazodone
- Triazolam
- Triclabendazole
- Trifluoperazine
- Trifluperidol
- Triflupromazine
- Trimeprazine
- Trimipramine
- Triptorelin
- Tryptophan
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Verapamil
- Vilanterol
- Vilazodone
- Vinflunine
- Voclosporin
- Voriconazole
- Vorinostat
- Vortioxetine
- Zaleplon
- Ziprasidone
- Zolpidem
- Zopiclone
- Zotepine
- Zuclopenthixol
Using buprenorphine/
- Clonidine
- Yohimbine
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using buprenorphine/
- Ethanol
Other medical problems
The presence of other medical problems may affect the use of buprenorphine/
- Addison disease (adrenal gland problem) or
- Alcohol abuse or dependence, or history of or
- Asthma, severe or
- Brain tumor, history of or
- Breathing problems, severe (eg, hypoxia, hypercapnia, sleep apnea) or
- Chronic obstructive pulmonary disease (COPD) or
- Cor pulmonale (serious heart condition) or
- Depression, history of or
- Drug abuse or dependence, especially with narcotics, or history of or
- Enlarged prostate (BPH, prostatic hypertrophy) or
- Gallbladder problems or
- Head injuries, history of or
- Heart disease or
- Hepatitis B or C, history of or
- Hypothyroidism (an underactive thyroid) or
- Hypovolemia (low blood volume) or
- Increased pressure in the head or
- Kyphoscoliosis (curvature of the spine with breathing problems) or
- Mental health problems, history of or
- Problems with passing urine or
- Stomach problems—Use with caution. May increase risk for more serious side effects.
- Hypotension (low blood pressure)—Use with caution. May make this condition worse.
- Liver disease, moderate—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
- Liver disease, severe—Should not be used in patients with this condition.
Proper use of buprenorphine/naloxone
Take buprenorphine/
Buprenorphine/
If you are using the buccal film:
- Use your tongue to wet the side of your cheek or rinse your mouth with water in the area where you will place the film.
- Do not cut or tear the film. Hold the film on a clean, dry finger. If you are using Bunavail®, hold with the text (BN2, BN4, or BN6) facing up.
- Place the side of the film against the inside of your cheek. If you are using Bunavail®, place with the text (BN2, BN4, or BN6) against the inside of your cheek.
- Press the film and hold it there for 5 seconds.
- Leave the film in place until it dissolves. Do not touch, move, chew, or swallow it.
- If you must use more than one film, place the second film on the other side of your mouth. Do not place more than 2 buccal films to the inside of one cheek at a time.
- Do not eat or drink anything until the film is completely dissolved.
If you are using the sublingual tablet:
- Do not cut, crush, chew, or swallow it.
- Place the tablet under the tongue until it is dissolved.
- If you take 2 or more tablets at a time, place all of the tablets in different places under the tongue at the same time.
- If this is uncomfortable, place 2 tablets at a time under the tongue and repeat the process until all the tablets have been taken.
- Do not eat or drink anything until the tablets are completely dissolved.
If you are using the sublingual film:
- Drink water before taking buprenorphine/
naloxone to help moisten your mouth. - Place the film under the tongue until it is dissolved.
- If you need to take an additional film, place the new film on the opposite side from the first film.
- Do not eat or drink anything until the film is completely dissolved.
- Do not cut, chew, swallow, or move the film after placing it under the tongue.
Check with your doctor first before changing dosage forms (eg, films, tablets) or dosage strengths. These forms are very different from each other.
Dosing
The dose of buprenorphine/
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For buccal dosage form (film):
- For induction treatment of opioid dependence:
- Adults—On Day 1, your doctor may give you an induction dosage up to 4.2 milligrams (mg) of buprenorphine and 0.7 mg of naloxone in divided doses. On Day 2, your doctor may give you up to 8.4 mg of buprenorphine and 1.4 mg of naloxone taken as a single dose. If you have been taking methadone, heroin, short-acting, or long-acting opioid medicines, your doctor may recommend you to take buprenorphine alone.
- Children—Use and dose must be determined by your doctor.
- For maintenance treatment of opioid dependence:
- Adults—8.4 milligrams (mg) of buprenorphine and 1.4 mg of naloxone taken as a single dose once a day. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
- For induction treatment of opioid dependence:
- For buccal or sublingual dosage form (film):
- For induction treatment of opioid dependence:
- Adults—On Day 1, your doctor may give you an induction dosage up to 8 milligrams (mg) of buprenorphine and 2 mg of naloxone in divided doses. On Day 2, your doctor may give you up to 16 mg of buprenorphine and 4 mg of naloxone taken as a single dose. If you have been taking methadone, heroin, short-acting, or long-acting opioid medicines, your doctor may recommend you to take buprenorphine alone.
- Children—Use and dose must be determined by your doctor.
- For maintenance treatment of opioid dependence:
- Adults—16 milligrams (mg) of buprenorphine and 4 mg of naloxone taken as a single dose once a day. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
- For induction treatment of opioid dependence:
- For sublingual dosage form (tablets):
- For induction treatment of opioid dependence:
- Adults—On Day 1, your doctor may give you an induction dosage up to 5.7 milligrams (mg) of buprenorphine and 1.4 mg of naloxone in divided doses. On Day 2, your doctor may give you up to 11.4 mg of buprenorphine and 2.9 mg of naloxone taken as a single dose. If you have been taking methadone, heroin, short-acting or long-acting opioid medicines, your doctor may recommend you take buprenorphine alone.
- Children—Use and dose must be determined by your doctor.
- For maintenance treatment of opioid dependence:
- Suboxone®:
- Adults—16 milligrams (mg) of buprenorphine and 4 mg of naloxone taken as a single dose once a day. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
- Zubsolv®:
- Adults—11.4 milligrams (mg) of buprenorphine and 2.9 mg of naloxone taken as a single dose once a day. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
- Suboxone®:
- For induction treatment of opioid dependence:
Missed dose
If you miss a dose of buprenorphine/
Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Drop off any unused narcotic medicine at a drug take-back location right away. If you do not have a drug take-back location near you, flush any unused narcotic medicine down the toilet. Check your local drug store and clinics for take-back locations. You can also check the DEA web site for locations. Here is the link to the FDA safe disposal of medicines website: www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm
Precautions while using buprenorphine/naloxone
It is very important that your doctor check your progress while you are using buprenorphine/
Do not use buprenorphine/
It is against the law and dangerous for anyone else to use your medicine. Keep your unused films or tablets in a safe and secure place. People who are addicted to drugs might want to steal buprenorphine/
Buprenorphine/
Using too much of buprenorphine/
Buprenorphine/
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are using buprenorphine/
Buprenorphine/
Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.
Buprenorphine/
Using buprenorphine/
Buprenorphine/
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Buprenorphine/
Do not suddenly stop using it without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help reduce the possibility of withdrawal symptoms, including anxiety, fever, nausea, runny nose, stomach cramps, sweating, tremors, or trouble with sleeping.
Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.
Using too much of buprenorphine/
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Buprenorphine/naloxone side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
- Chills
- cough
- feeling faint, dizzy, or lightheaded
- feeling of warmth or heat
- fever
- flushing or redness of the skin, especially on the face and neck
- headache
- hoarseness
- lower back or side pain
- painful or difficult urination
- sweating
Incidence not known
- Agitation
- bloating or swelling of the face, arms, hands, lower legs, or feet
- chest tightness
- darkening of the skin
- diarrhea
- difficulty swallowing
- dizziness
- fainting
- fast heartbeat
- hives, itching, skin rash
- loss of appetite
- mental depression
- nausea
- overactive reflexes
- poor coordination
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- rapid weight gain
- restlessness shivering talking or acting with excitement you cannot control
- tingling of the hands or feet
- trembling or shaking twitching
- unusual weight gain or loss
- vomiting
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
- Blurred vision
- confusion
- difficult or trouble breathing
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- drowsiness
- irregular, fast, slow, or shallow breathing
- pale or blue lips, fingernails, or skin
- pinpoint pupils
- relaxed and calm feeling
- sleepiness
- unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Difficulty having a bowel movement
- lack or loss of strength
- stomach pain
- trouble sleeping
Less common
- Back pain
- diarrhea
- runny or stuffy nose
- sneezing
Incidence not known
- Burning or sore mouth
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings inside the mouth
- decline or loss of libido or sexual desire
- irritability
- mood swings
- poor concentration
- redness, swelling, or soreness of the tongue
- reduced muscle strength
- swelling, inflammation, or redness of the mouth
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Frequently asked questions
- What are the different types of buprenorphine/
naloxone? - How long does Bunavail block opiates?
- Can Bunavail (buprenorphine/
naloxone) be cut in half? - Are Bunavail and Suboxone the same thing?
- How long does Bunavail (buprenorphine/
naloxone) take to dissolve? - What is the difference between Cassipa and Suboxone sublingual film?
- How long does Bunavail (buprenorphine/
naloxone) last?
More about buprenorphine / naloxone
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Patient resources
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- Buprenorphine and Naloxone Buccal Film
- Buprenorphine and Naloxone Sublingual Film (Suboxone)
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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.