Suboxone: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on April 5, 2023.

1. How it works

• Suboxone is a brand (trade) name for a combination tablet that combines buprenorphine with naloxone. Suboxone may be used to treat opioid misuse disorder.
• Suboxone contains buprenorphine and naloxone. Buprenorphine is an opioid (narcotic) that has a unique and complex mechanism of action, which includes incomplete binding to mu opioid receptors and complete binding to kappa opioid receptors. Opioid receptors have three main effects: reducing breathing (respiratory depression), producing euphoria (feelings of intense happiness or excitement), and decreasing pain. The way buprenorphine binds means it can satisfy opioid cravings without producing strong feelings of euphoria or causing significant respiratory depression. In addition, while it is bound to opioid receptors, other opioids (such as heroin or oxycodone) cannot bind. It also stays on the receptors for longer - about three days; which makes it a good choice for use in opioid addiction treatment programs.
• Naloxone is present in this combination tablet to discourage misuse. Naloxone is a very strong blocker of mu opioid receptors and will precipitate people into opioid withdrawal if drug misusers attempt to convert the tablet into an injectable form. Naloxone has virtually no other effect when taken sublingually.
• Suboxone helps to reduce withdrawal symptoms and curb cravings for opioids by tricking the brain into thinking that a full agonist like oxycodone or heroin has been taken.
• Suboxone is used in the treatment of opioid (narcotic) addiction.

2. Upsides

• May be used for the treatment of opioid addiction.
• Has advantages over other medication-assisted treatments (such as methadone and naltrexone) in that it suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria (the feeling or state of intense excitement and happiness), and also blocks the effects of other opioids for at least 24 hours.
• Helps people to change their thinking, behavior, and environment. Complements education, counseling, and other support measures that focus on the behavioral aspects of opioid addiction.
• Success rates of 40-60% have been reported; far higher than the under 25% success rate achieved by going cold turkey.
• Long-acting, only needs to be taken once a day.
• If full opioids are taken within 24 hours of a Suboxone dose, they will not work, allowing the patient time to reconsider the wisdom of relapsing.
• Suboxone is available as a generic under the name buprenorphine hydrochloride/naloxone hydrochloride sublingual tablets.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• A headache, chills, drowsiness, constipation, rhinitis, nausea, pain, insomnia, sweating, a lack of energy, or a drop in blood pressure when going from a standing to a sitting position.
• Allergic reactions (including breathing difficulties, rash, and anaphylactic shock) and liver damage have been reported.
• Can only be prescribed under the Suboxone REMS Program by physicians who meet certain qualifying requirements, and who have been assigned a unique identification number that must be included on every prescription.
• Abuse potential exists, although it is substantially lower than methadone. Take steps to store your medicines safely to minimize the risk of theft and misuse. Treatment is also regulated, but not as highly regulated as methadone treatment. Misuse of Suboxone can cause addiction, overdose, or death.
• Buprenorphine preparations have been associated with breathing difficulties and death, most often with the IV form when used at the same time as benzodiazepines, alcohol, or other CNS depressant drugs. Avoid self-administration of other medications while taking Suboxone except on a doctor's advice.
• May not be suitable for people with head injuries, acute abdominal conditions, or preexisting respiratory disease (such as COPD or asthma).
• Can also cause dependence and a withdrawal syndrome on abrupt discontinuation although this is typically milder than that seen with full agonists.
• May interact with some medications including some antifungals and HIV antiretrovirals.
• May be habit-forming, even at the dosage prescribed by your doctor.
• May cause sleepiness or dizziness and affect a person's ability to drive or operate machinery. Alcohol should be avoided
• Abnormal liver function tests have also been reported; ongoing tests that monitor liver function may be needed.
• May cause a severe lowering of blood pressure, or a sudden drop in blood pressure when going from sitting to standing.
• Risk of heart rhythm disorders (such as QT prolongation), particularly at higher dosages.
• Suboxone is not interchangeable with other brands of buprenorphine/naloxone (for example, Suboxone sublingual tablets require a different dose than Bunavail buccal film). Monitor for signs of over-medication as well as withdrawal or under-dosing when switching brands.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Suboxone is a combination medicine containing buprenorphine and naloxone that is used to treat adults addicted to opioid medications. It should be used in conjunction with a complete treatment program that includes counseling and behavioral therapy. Although less likely to be abused than methadone, the potential for abuse still exists.

5. Tips

• Suboxone should always be used as part of a complete treatment plan that includes counseling and psycho-social support. Subutex (buprenorphine) tablets are usually used initially for induction before Suboxone is prescribed.
• Suboxone sublingual tablets should be placed under the tongue and allowed to dissolve. Swallowing the tablets reduces their effectiveness. Do not eat or drink anything until Suboxone has completely dissolved.
• Continued treatment with Suboxone usually depends on compliance with all elements of the treatment plan and abstinence from illicit drug use.
• Take exactly as directed; do not misuse.
• Seek immediate medical help if you develop blurred vision, are excessively sleepy or uncoordinated, have slurred speech, have slowed reflexes or breathing, or have significant problems thinking.
• Suboxone is not interchangeable with other brands of buprenorphine/naloxone. When switching between brands, dosage adjustments may be necessary. Talk with your doctor.
• Suboxone can cause sedation and affect your ability to drive or operate machinery. Do not drink alcohol while you are taking this medication.
• Talk to your doctor or pharmacist before taking any other medications or natural products with Suboxone because it may not be compatible with some products.
• Keep out of reach of children and pets because even one dose can be fatal.
• Tell other health providers including dentists that you are being treated with Suboxone.

6. Response and effectiveness

• Quickly absorbed via the sublingual route. Maximum concentrations are reached within two hours.
• There may be a difference in effectiveness between Suboxone sublingual tablets and Suboxone sublingual film. Those switching may need to be monitored for over or under-medication.

7. Interactions

Medicines that interact with Suboxone may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Suboxone. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Suboxone include:

• 5-hydroxytryptophan
• albuterol
• antibiotics, such as azithromycin, clarithromycin, erythromycin, and norfloxacin
• antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
• antifungal agents, such as itraconazole and ketoconazole
• anticonvulsants, such as brivaracetam, carbamazepine, divalproex, lamotrigine, phenytoin, phenobarbital, or primidone
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, aripiprazole, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as benzodiazepines (eg, alprazolam, diazepam, lorazepam), sleeping pills (such as zolpidem or ziprasidone), or first-generation antihistamines (such as doxylamine or promethazine)
• bisacodyl
• bupropion
• buspirone
• busulfan
• cannabis
• cyclosporine
• dapsone
• dasatinib
• droperidol
• echinacea
• flucloxacillin
• heart medications such as amlodipine, atenolol, or candesartan
• HIV medications, such as delavirdine or ritonavir
• metoclopramide
• muscle relaxants, such as baclofen or cyclobenzaprine
• opioids such as codeine, fentanyl, or morphine
• pregabalin
• rifampin
• sodium oxybate
• valerian
• other medications that affect serotonin, such as amphetamines, lithium, tramadol, or triptans (eg, almotriptan, eletriptan, or sumatriptan).

Avoid grapefruit products and drinking alcohol or taking illegal or recreational drugs while taking Suboxone.

Note that this list is not all-inclusive and includes only common medications that may interact with Suboxone. You should refer to the prescribing information for Suboxone for a complete list of interactions.

References

• Suboxone (buprenorphine hydrochloride and naloxone hydrochloride) [Package Insert] Revised: 05/2022. Indivior Inc. https://www.drugs.com/pro/suboxone.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Suboxone only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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