buprenorphine / naloxone
Suboxone tablets (buprenorphine / naloxone) are used for the maintenance treatment of opioid use disorder (OUD) in adults. This medication-assisted treatment is given along with counseling and social and emotional support. It contains two active ingredients: buprenorphine is a partial opioid agonist, and naloxone is an opioid antagonist. The tablets are taken sublingually once per day (they're placed under the tongue where they dissolve). The dosage depends on each person's situation. Side effects include headache, pain, and nausea. It's a controlled substance because it has a risk of being addictive and being misused.
Note: The Suboxone brand name for the sublingual tablets is discontinued, but there are generic versions available. Buprenorphine/naloxone sublingual tablets are also available under the brand name Zubsolv.
What is Suboxone tablets (buprenorphine / naloxone)?
What is Suboxone tablets (buprenorphine / naloxone) used for?
Maintenance treatment for opioid use disorder (OUD) in adults (together with counseling and therapy)
How Suboxone tablets (buprenorphine / naloxone) works
Suboxone tablets (buprenorphine / naloxone) are a combination of two medications that work together to treat opioid use disorder.
Buprenorphine is a partial opioid agonist. It works by attaching to opioid receptors in the brain similar to other opioid medications. But buprenorphine doesn't turn on these receptors as strongly as other opioids. This helps ease opioid cravings and lessen the risk for withdrawal symptoms in someone with opioid use disorder without causing the same "high" as other opioid medications.
Naloxone is an opioid antagonist. It blocks the opioid receptors in your brain. Naloxone doesn't affect the actions of buprenorphine when Suboxone tablets (buprenorphine / naloxone) are dissolved on the tongue. But it will block the effects of buprenorphine and cause withdrawal symptoms if Suboxone tablets (buprenorphine / naloxone) were to be misused by injection or in other ways. This is meant to prevent people from misusing buprenorphine.
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What are the risks and warnings for Suboxone tablets (buprenorphine / naloxone)?
Suboxone tablets (buprenorphine / naloxone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Potential for addiction and misuse
Risk factors: History of alcohol or substance use disorder | Taking more Suboxone tablets (buprenorphine / naloxone) than prescribed
Suboxone is a schedule III controlled substance because it contains the opioid buprenorphine. Buprenorphine has a risk for misuse and dependence. Misusing Suboxone tablets (buprenorphine / naloxone) can raise the risk for addiction and other serious side effects, such as dangerously slow breathing and overdose. Take Suboxone tablets (buprenorphine / naloxone) exactly as prescribed. Don't change how much you take or how often you take it without talking to your prescriber first.
Potentially life-threatening slowed breathing (respiratory depression)
Risk factors: Age 65 years or older | Chronic obstructive pulmonary disease (COPD) | Other medical conditions that cause or raise the risk for slow breathing | Taking sedatives or other medications that can slow down breathing | Drinking alcohol
Suboxone contains buprenorphine, which can cause dangerously slow breathing. This can be life-threatening. Your risk is higher if you take other medications that can slow your body down like benzodiazepines and opioids. Drinking alcohol with Suboxone tablets (buprenorphine / naloxone) also raises your risk for slowed breathing. In addition, people getting treated for opioid use disorder can sometimes relapse, which puts them at high risk for breathing problems from opioid use.
Your prescriber might recommend that you always have naloxone (Narcan) with you in case you need to quickly treat any slowed breathing from Suboxone tablets (buprenorphine / naloxone) or other opioids. It's important for you and your loved ones to know how to use naloxone (Narcan) if you start breathing extremely slowly. Give naloxone (Narcan) and call 911 right away if you or a loved one notices that you're having trouble breathing or that you have bluish-colored lips.
Risk for opioid overdose
Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high opioid doses | Taking more opioids than prescribed | Taking sedatives or other medications that can cause slowed breathing | Drinking alcohol | Age 65 years and older | Age 18 years and younger
People who are getting treated for opioid use disorder are at risk for relapse, meaning that they can fall back into taking opioids again. In general, opioids have a risk for overdose. An opioid overdose can happen at recommended doses of opioids. It can also happen if you take higher doses than prescribed or take the medication more often than prescribed. What's more, a fatal overdose can happen in children if they accidentally take just one dose of an opioid medication like Suboxone tablets (buprenorphine / naloxone).
An opioid overdose can be life-threatening if it's not recognized or treated in time. Overdose symptoms include extremely slowed breathing, slow heartbeat, extreme sleepiness, cold or clammy skin, or not responding to sound or touch. Call 911 right away if you think an overdose has happened.
Your prescriber might suggest to always carry naloxone (Narcan), a medication that's used to help reverse life-threatening opioid overdose. It's important for you and your loved ones to know when and how to use naloxone (Narcan) in case an accidental overdose happens. Store your medications out of reach from children, pets, and visitors.
Difficulty concentrating and extreme sleepiness
Risk factors: Age 65 years and older | Taking other medications that make you less alert or slow your body down | Drinking alcohol
Suboxone tablets (buprenorphine / naloxone) can cause extreme sleepiness. It can also lower your ability to think, react, and focus. Drinking alcohol and taking other medications that slow your body down, like benzodiazepines, sedatives, and muscle relaxants, can worsen these side effects.
Make sure you know how Suboxone tablets (buprenorphine / naloxone) affect you before driving a car or doing activities that require your concentration. Avoid drinking alcohol or taking medications that make you sleepy while you're taking Suboxone tablets (buprenorphine / naloxone). Talk to your care team right away if you feel too sleepy from taking Suboxone tablets (buprenorphine / naloxone).
Harm to newborn babies
Risk factors: Taking Suboxone tablets (buprenorphine / naloxone) during pregnancy
During pregnancy, opioids can travel through your bloodstream to your unborn baby. Long-term opioid use during pregnancy can cause your unborn baby to become dependent on the medication.
Once your baby is born, they can experience withdrawal symptoms, including high-pitched crying, poor feeding and sucking behavior, trembling, irritability, abnormal sleep patterns, and even seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare team know if you've taken Suboxone tablets (buprenorphine / naloxone) during pregnancy and if you notice your newborn having these withdrawal symptoms.
Low adrenal hormone levels
Risk factors: Taking Suboxone tablets (buprenorphine / naloxone) for longer than 1 month
Some people who take medications containing opioids, like Suboxone tablets (buprenorphine / naloxone), can have a drop in their adrenal hormone levels. This is more likely if people take the medication for longer than 1 month. Tell your prescriber right away if you have symptoms of low adrenal hormones, including nausea, vomiting, not feeling hungry, tiredness, dizziness, and weakness. You might need to work with your prescriber to stop Suboxone tablets (buprenorphine / naloxone) and then get treated with corticosteroids.
Withdrawal symptoms
Risk factors: Long-term use of Suboxone tablets (buprenorphine / naloxone) or other opioids | Stopping or lowering the dose of Suboxone tablets (buprenorphine / naloxone) suddenly | Starting Suboxone tablets (buprenorphine / naloxone) before the full effect of other opioids have worn off | Liver damage
Taking Suboxone tablets (buprenorphine / naloxone) for a long period of time can cause physical dependence. This means that your body relies on the medication to function and you can experience withdrawal if you lower the dose too quickly or stop taking the medication suddenly. Withdrawal symptoms include anxiety, restlessness, irritability, cravings, runny nose, yawning, sweating, chills, and body aches.
Withdrawal can also happen if you take Suboxone tablets (buprenorphine / naloxone) before the effects of any other opioids have worn off. In addition, misusing Suboxone tablets (buprenorphine / naloxone) by self-injection can lead to withdrawal symptoms in people who are physically dependent on other opioids.
It's important that you take Suboxone tablets (buprenorphine / naloxone) exactly as prescribed. Don't lower your dose or stop taking the medication suddenly without talking to your prescriber. They will slowly lower your dose to prevent withdrawal symptoms.
Liver damage
Risk factors: History of liver damage | Hepatitis B or C infection | Taking other medications that can cause liver damage | Injection drug use
Some people who've taken buprenorphine-containing medications developed liver damage. This damage can range from mild to severe and life-threatening (liver failure). You'll need to get blood tests done before you start taking Suboxone tablets (buprenorphine / naloxone) and periodically during treatment to make sure your liver is healthy.
It's not recommended for people with moderate-to-severe liver conditions to take Suboxone tablets (buprenorphine / naloxone). Liver damage lowers your body's ability to clear naloxone from your system, much more so than buprenorphine. This can make the levels of naloxone in your body rise and lead to withdrawal symptoms when you first start Suboxone tablets (buprenorphine / naloxone). Talk to your prescriber about other options that can help with your opioid dependence if you have liver problems.
Dental problems
Some people who took buprenorphine-containing medications that are dissolved in the mouth have had dental problems. These problems included cavities, tooth infections, damaged teeth, and even tooth loss.
Be sure to get regular dental cleanings and check-ups with your dentist. Practice good oral hygiene, and brush your teeth and floss every day. After the Suboxone tablets (buprenorphine / naloxone) dissolve under the tongue, swish some water around in your mouth and then swallow. Make sure to wait at least 1 hour after you take the Suboxone tablets (buprenorphine / naloxone) before you brush your teeth.
Life-threatening heart rhythm problem (QT prolongation)
Risk factors: Heart rhythm problems | Heart failure | Electrolyte levels that aren't balanced in the body
Suboxone contains buprenorphine, which can cause QT prolongation (the time it takes for the heart to relax and contract again is longer than usual). This can potentially lead to a dangerous heart rhythm problem.
Tell your prescriber about your full medical history before you start taking Suboxone tablets (buprenorphine / naloxone). Your risk for QT prolongation might be higher if you already have heart problems or if you have abnormal electrolyte levels in your body. Contact your prescriber if you have symptoms of heart problems, such as a pounding chest, trouble breathing, feeling faint or lightheaded, or chest pain, while you're taking this medication.
Low blood pressure
Suboxone tablets (buprenorphine / naloxone) can cause extremely low blood pressure. Your blood pressure might drop when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. Talk to a healthcare professional if any dizziness or lightheadedness doesn't go away.
Not for use for pain or for people who haven't taken opioids before
Fatal overdoses have happened when people who haven't taken opioids before took a buprenorphine tablet for pain. Suboxone tablets (buprenorphine / naloxone) are only for people who've taken opioids before. Suboxone tablets (buprenorphine / naloxone) aren't meant to be taken as a pain reliever.
What are the side effects of Suboxone tablets (buprenorphine / naloxone)?
Common Side Effects
- Headache (36%)
- Withdrawal symptoms, such as anxiety, goosebumps, stomach discomfort, irritability, cold sweat, joint pain, and watery eyes (25%)
- General pain (22%)
- Nausea (15%)
- Sweating (14%)
- Trouble sleeping (14%)
- Constipation (12%)
- Stomach pain (11%)
Other Side Effects
- Dizziness or lightheadedness
- Mouth numbness
- Burning sensation in the mouth or tongue
- Reddening or swelling inside the mouth
- Swelling in the hands or ankles
- Body weakness
- Back pain
- Chills
- Runny nose
- Diarrhea
- Vomiting
- Infection
Serious Side Effects
- Opioid withdrawal: anxiety, restlessness, irritability, muscle or joint aches, nausea, vomiting, sweating, chills, shaking, sleep problems
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Heart rhythm problems: chest pounding, chest pain, fluttering in the chest, trouble breathing, feeling faint or lightheaded
- Serious allergic reaction: rash; hives; itchiness; fast heartbeat; dizziness; trouble breathing; swelling of lips, mouth, or around the eyes
Source: DailyMed
More on Suboxone tablets (buprenorphine / naloxone) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Headache
- Nausea
- Vomiting
Pros and cons of Suboxone tablets (buprenorphine / naloxone)
Pros
Available as a lower-cost generic
Comes as a tablet that's dissolved under the tongue
Causes milder withdrawal symptoms than other common opioids if stopped suddenly
Cons
Can cause bothersome side effects, such as headache, trouble sleeping, and nausea
Has a risk for misuse and dependency
Is a controlled substance, so there are special requirements for filling a prescription
Pharmacist tips for Suboxone tablets (buprenorphine / naloxone)
Suboxone tablets (buprenorphine / naloxone) are typically given a part of a treatment plan that also includes counseling and therapy. Ask your prescriber about additional resources to help treat your opioid dependence.
Don't stop or lower your Suboxone tablets (buprenorphine / naloxone) dose suddenly without talking to your prescriber first. Your dose will need to be lowered slowly over a period of time to prevent withdrawal symptoms like shaking, nausea, muscle aches, irritability, and anxiety.
Make sure to practice good oral hygiene and visit your dentist regularly for cleanings. Suboxone tablets (buprenorphine / naloxone) can cause problems with your teeth.
Tell your care team about all of the medications you're taking so they can check that your medications are safe to take together. Taking Suboxone tablets (buprenorphine / naloxone) together with benzodiazepines, sedatives, or alcohol can worsen side effects like slow breathing and severe sleepiness. This can be life-threatening.
If you need to take pain medications, make sure to let your prescriber know that you're taking Suboxone tablets (buprenorphine / naloxone) so they can choose a safe treatment option for you. It's best to start with non-opioid medications first to relieve pain. Taking an opioid medication with Suboxone tablets (buprenorphine / naloxone) can put you at risk for serious side effects, such as sleepiness and breathing problems.
Place Suboxone tablets (buprenorphine / naloxone) somewhere that's out of reach from children, pets, or visitors. If you don't need to take the medication anymore, get rid of it through a take-back program or flush it down the toilet after you remove the tablets from the package. This lowers the risk for an accidental overdose and it helps prevent medication misuse.
Don't take out the tablet until you're ready to take your dose. Be sure your hands are dry when you take the medication. This prevents the tablet from dissolving in your hand before you place it in your mouth.
Don't cut the tablet because you might cut the tablet unevenly and take the wrong dose. It's possible that you might take a lower dose than recommended, which can lead to withdrawal symptoms.
Place the tablet under your tongue, and let it dissolve all the way. Don't chew or swallow the tablet while it's dissolving. Also, don't talk while the tablet is dissolving because this can affect how well the medication gets absorbed into the body.
Don't move the tablet once it's placed in your mouth, and don't eat or drink anything until it's completely dissolved. This makes sure you get the full dose of medication.
After the tablet completely dissolves, rinse your mouth gently with a sip of water and swallow. Wait for at least an hour after you take the medication to brush your teeth to avoid damage to your teeth.
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Suboxone tablets (buprenorphine / naloxone) dosage forms
Typical dosing for Suboxone tablets (buprenorphine / naloxone)
In general, your prescriber will work with you to adjust the dose of your medications for opioid use disorder based on your individual needs.
Before you can take Suboxone tablets (buprenorphine / naloxone), your treatment will need to first start off with buprenorphine sublingual tablets. Then, your prescriber will transition you to the Suboxone tablets (buprenorphine / naloxone) for maintenance treatment.
The typical dose for Suboxone tablets (buprenorphine / naloxone) ranges from 4 mg/1 mg (buprenorphine/naloxone) to 24 mg/6 mg (buprenorphine/naloxone) dissolved under the tongue (sublingually) once per day.
How much does Suboxone tablets (buprenorphine / naloxone) cost?
Suboxone tablets (buprenorphine / naloxone) contraindications
Severe allergy to buprenorphine or naloxone
What are alternatives to Suboxone tablets (buprenorphine / naloxone)?
Maintenance treatment for opioid use disorder (OUD) in adults (together with counseling and therapy)
Treatment of opioid use disorder (OUD) in adults (in addition to counseling and therapy)
Opioid use disorder in adults (in addition to counseling and therapy programs)
What is the latest news about Suboxone tablets (buprenorphine / naloxone)?
Suboxone tablets (buprenorphine / naloxone) images
References
Best studies we foundCenters for Disease Control and Prevention. (2024). About opioid use during pregnancy.
Centers for Disease Control and Prevention. (2024). Oral health tips for adults.
Department of Justice/Drug Enforcement Administration. (2020). Narcotics.
Gunderson, E. W., et al. (2016). Efficacy of buprenorphine/naloxone rapidly dissolving sublingual tablets (BNX-RDT) after switching from BNX sublingual film. Journal of Addiction Medicine.
Khanna, I. K., et al. (2015). Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain. Journal of Pain Research.
MedlinePlus. (2023). Drug use and addiction.
MedlinePlus. (2023). Prescription drug misuse.
MedlinePlus. (2024). Opiate and opioid withdrawal.
National Institute of Dental and Craniofacial Research. (2024). Oral hygiene.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Symptoms & causes of adrenal insufficiency & Addison's disease.
National Institute on Drug Abuse. (2023). Initiating buprenorphine treatment in the emergency department.
PAI Holdings, LLC dba Pharmaceutical Associates, Inc. and dba PAI Pharma. (2024). Buprenorphine and naloxone- buprenorphine hydrochloride and naloxone hydrochloride tablet [package insert]. DailyMed.
Substance Abuse and Mental Health Services Administration. (2004). 4 Treatment protocols. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.
U.S. Food and Drug Administration. (2022). FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain.
U.S. Food and Drug Administration. (2024). Drug disposal: Drug take-back options.
U.S. Food and Drug Administration. (2024). Drug disposal: FDA’s flush list for certain medicines.
Velander, J. R. (2018). Suboxone: Rationale, science, misconceptions. Ochsner Journal.
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