Other Brands/Names

Suboxone, Subutex.

How It Works

Buprenorphine is often combined with naloxone, a medicine used to counter opioid effects. The buprenorphine-naloxone combination is intended to prevent withdrawal, the cluster of physical and psychological symptoms that can occur when a person dependent on opioids stops taking them. When opioid use is discontinued (opioids are pain-relief medicines that can be addictive if misused), buprenorphine can lessen or prevent withdrawal symptoms and help stabilization.

Indications

Buprenorphine with naloxone is commonly used to treat dependence on opioid drugs, including heroin and prescription narcotic pain relievers.

Contraindication

Do not use this medicine in the following situations:

• Known hypersensitivity or allergy to buprenorphine or naloxone
• Patients younger than 16 years
• Severe respiratory depression
• Severe hepatic impairment
• Alcohol addiction
• Delirium (confused thinking with reduced awareness of surroundings)

Side Effects

This medicine can cause the following effects:

• Drowsiness
• Dizziness
• Constipation
• Headache 
• Severe and potentially fatal respiratory depression can occur if this medicine is misused or combined with other substances such as alcohol or additional opioid medicines.

Tell your doctor immediately if any of these serious effects appear:

• Sleep-disordered breathing
• Mental or mood changes (restlessness, confusion, hallucinations)
• Stomach pain
• Tooth or gum pain
• Unusual fatigue
• Unintended weight loss

Types

Sublingual tablets that are placed under the tongue, not swallowed, and left in place until the tablet fully dissolves.

Dosage

The following dose of buprenorphine is intended to adults:

• Initial dose: 0.8–4 mg once daily, increased as needed.
• Maximum maintenance dose: 32 mg per day.

Once the patient is stable, the dose may be tapered gradually and treatment can be stopped under supervision. In opioid-dependent individuals who have not yet developed withdrawal, the first dose should be delayed until clear signs of withdrawal appear or at least 6 hours after the last opioid use. For patients receiving methadone, reduce the methadone dose to 30 mg daily or less before starting therapy.

Safety

This medicine may make you dizzy or drowsy. Do not drive, operate machinery, or do activities that require alertness until you can do them safely. Avoid alcoholic beverages.

During pregnancy, use only if clearly needed. Use during the first two months may slightly raise the risk of birth defects, and prolonged use or high doses close to delivery may harm the fetus or newborn. To reduce risk, use the lowest effective dose for the shortest necessary time under medical guidance.

Drug Interactions

The risk of serious side effects (slowed or shallow breathing, marked drowsiness, severe dizziness) increases if used with other substances that depress breathing or cause sedation, such as:

• Alcohol
• Marijuana
• Antihistamines for allergy (e.g., cetirizine, diphenhydramine)
• Medicines for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem)
• Muscle relaxants (e.g., carisoprodol, cyclobenzaprine)
• Other opioid pain relievers (e.g., codeine, hydrocodone)

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