
buprenorphine
Buprenorphine sublingual tablets are used to treat opioid use disorder (OUD) in adults. It belongs to a drug class called partial opioid agonists. Together with counseling and other therapy, it helps reduce opioid cravings and ease withdrawal symptoms. Buprenorphine tablets are often used during the first stage of treatment, but some people might need to take it for longer. The tablet is placed under the tongue and dissolves on its own. Side effects can include headache, nausea, and trouble sleeping. This medication is a controlled substance because it has a risk of misuse and dependence.
What is Buprenorphine?
What is Buprenorphine used for?
- Treatment of opioid use disorder (OUD) in adults, with counseling and therapy
How Buprenorphine works
Buprenorphine is a partial opioid agonist. It attaches to certain opioid receptors in the brain but only partly activates them. This helps reduce opioid cravings and ease withdrawal symptoms. Because it only partly activates these receptors, it doesn't cause the same "high" as other opioid medications. It might also have a lower risk of certain opioid side effects.
Drug facts
| Common Brands | Subutex |
|---|---|
| Drug Class | Opioid partial agonist |
| Controlled Substance Classification | Schedule III |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Risks and warnings for Buprenorphine
Buprenorphine 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.
Risk of addiction and misuse
- Risk factors: History of alcohol use disorder | History of substance use disorder
Buprenorphine is a schedule III controlled substance. Opioids like buprenorphine have a risk of misuse and dependence. Misusing the medication can raise the risk of addiction. It can also raise the risk of other serious side effects, such as dangerously slow breathing and overdose.
Take buprenorphine exactly as prescribed. Don't change your dose or how often you take it without talking to your prescriber first.
Dangerously slow breathing (respiratory depression)
- Risk factors: Age 65 years or older | Chronic obstructive pulmonary disease (COPD) or other breathing problems | Other medical conditions that cause or raise the risk for slow breathing | Taking sedatives, opioids, or other medications that can slow breathing at the same time | Drinking alcohol
Buprenorphine can cause dangerously slow breathing. This can be life-threatening. Your risk is higher if you take other medications that can slow your breathing. This includes benzodiazepines and other opioids. The risk is also higher if you drink alcohol with buprenorphine.
Your prescriber might recommend that you have naloxone (Narcan). It can quickly reverse an opioid overdose, including slowed breathing. Make sure you and your loved ones know how to use naloxone. Give naloxone and call 911 right away if you have trouble breathing, your lips turn blue, or you can't be woken up.
Risk of opioid overdose
- Risk factors: History of opioid use disorder | Previous opioid overdose | Taking opioids while taking buprenorphine | Taking sedatives or other medications that can cause slowed breathing | Drinking alcohol | Accidental exposure in children
People being treated for opioid use disorder are at risk of having a relapse. This means they might start using opioids again, which can raise their risk of an opioid overdose. In addition, even one dose of an opioid medication like buprenorphine can be dangerous for a child who takes it by accident.
An opioid overdose can be life-threatening. Signs of an opioid overdose include very slow breathing, a slow heartbeat, extreme sleepiness, cold or clammy skin, or not waking up. Call 911 right away if you think someone has overdosed.
Your prescriber might recommend carrying naloxone (Narcan), a medication that can reverse an opioid overdose. Make sure you and your loved ones know when and how to use it in case an accidental overdose happens. Store buprenorphine out of the reach of children, pets, and visitors.
Extreme sleepiness and trouble concentrating
- Risk factors: Age 65 years and older | Taking other medications that make you less alert or slow your body down | Drinking alcohol
Buprenorphine can make you very sleepy. It can also make it harder to think clearly, react quickly, and focus. Alcohol can make these effects worse. Medications that make you sleepy, like benzodiazepines, sedatives, and muscle relaxants, can also make the effects worse.
Don't drive or do anything that requires you to be alert until you know how buprenorphine affects you. Avoid drinking alcohol or taking medications that make you sleepy unless your prescriber says it's safe. Tell your care team right away if you feel very sleepy while taking buprenorphine.
Harm to a newborn baby
- Risk factors: Taking buprenorphine during pregnancy
Taking buprenorphine during pregnancy can cause your unborn baby to become physically dependent on the medication. This happens because opioids can pass from your bloodstream to your baby during pregnancy.
After birth, your baby can have withdrawal symptoms. These can include high-pitched crying, poor feeding, shaking, irritability, unusual sleep patterns, or seizures. This is called neonatal opioid withdrawal syndrome (NOWS). It can be serious if it's not spotted and treated in time.
Tell your healthcare team if you took buprenorphine during pregnancy. Also tell them if your newborn has signs of withdrawal.
Low adrenal hormone levels
- Risk factors: Taking buprenorphine for longer than 1 month
Opioids like buprenorphine might lower your adrenal hormone levels. This is more likely to happen if you take it for longer than 1 month. Tell your prescriber right away if you have symptoms of low adrenal hormones. These can include nausea, vomiting, loss of appetite, tiredness, dizziness, or weakness. If this happens, your prescriber might work with you to stop buprenorphine. Then, they might treat you with a corticosteroid medication.
Withdrawal symptoms
- Risk factors: Long-term use of buprenorphine or other opioids | Stopping or lowering the dose of buprenorphine suddenly | Taking buprenorphine too soon after using another opioid | Liver damage
Taking buprenorphine for a long time can cause physical dependence. This means your body gets used to the medication. When this happens, stopping it suddenly or lowering the dose too fast can cause withdrawal. Symptoms can include anxiety, restlessness, irritability, cravings, a runny nose, sweating, chills, and body aches.
Take buprenorphine exactly as prescribed. Don't stop taking it or lower your dose without talking to your prescriber. If you need to stop treatment, your prescriber will slowly lower your dose to help prevent withdrawal symptoms.
Liver problems
- Risk factors: History of liver damage | Hepatitis B or C infection | Taking other medications that can cause liver damage | Injection drug use
Tell your prescriber if you have liver problems before starting buprenorphine. This medication isn't recommended for people with moderate or severe liver problems. Liver problems can cause the naloxone component to build up in your body. This might trigger withdrawal symptoms when you first start treatment. Your prescriber can help decide whether this medication is right for you.
Also, some people who've taken buprenorphine have developed liver problems. These can range from mild to severe and life-threatening. Your prescriber will check your liver with blood tests before you start buprenorphine. They might also check from time to time during treatment. This helps your prescriber find problems early.
Dental problems
Some people who take buprenorphine medications that dissolve in the mouth have had dental problems. These problems can include cavities, tooth infections, damaged teeth, and even tooth loss. Some people needed dental treatments, such as fillings, root canals, or tooth removal.
Help protect your teeth by getting regular dental checkups. Practice good oral hygiene, and brush your teeth and floss every day. After the buprenorphine dissolves under your tongue, swish water around your mouth and swallow it. Wait at least 1 hour after you take the medication brushing your teeth.
Life-threatening heart rhythm problem (QT prolongation)
- Risk factors: Low heart rate | Heart rhythm problems, such as atrial fibrillation (AFib) | Heart failure | Low potassium | Low magnesium | Taking digoxin
Buprenorphine can cause QT prolongation. This is when the heart takes longer than usual to reset between beats. In rare cases, this can lead to a serious heart rhythm problem.
Before starting buprenorphine, tell your prescriber about your medical history. Your risk of QT prolongation might be higher if you have certain heart problems or abnormal electrolyte levels. Your prescriber can check your risk and make sure buprenorphine is safe for you.
Call your prescriber right away if you have signs of an irregular heartbeat. This can include a pounding or racing heart, trouble breathing, feeling faint or lightheaded, or chest pain.
Low blood pressure
Buprenorphine can cause your blood pressure to drop when you stand. This is called orthostatic hypotension. The sudden drop in blood pressure can make you feel dizzy or faint.
To avoid falling, stand up slowly while holding onto something stable. Be sure to sit back down if you feel dizzy and wait until you feel better. Talk to a healthcare professional if any dizziness or lightheadedness doesn't go away.
Side effects of Buprenorphine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (29%)
- Trouble sleeping (21%)
- General pain (18%)
- Opioid withdrawal symptoms (18%)
- Nausea (14%)
- Sweating (13%)
- Stomach pain (12%)
- Infection (12%)
Less Common Side Effects
- Mouth numbness
- Burning sensation in the mouth
- Reddening or swelling inside the mouth
- Dizziness or lightheadedness
- Weakness
- Chills
- Vomiting
- Constipation
- Diarrhea
- Runny nose
- Back pain
Buprenorphine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Heart rhythm problems: chest pounding, fluttering in the chest, chest pain, trouble breathing, feeling faint or lightheaded
- Serious allergic reaction: rash; hives; flushing (feeling warm suddenly); fast heartbeat; dizziness; trouble breathing; throat tightness; swelling of the lips, mouth, or around the eyes
More on Buprenorphine side effects
The following Buprenorphine side effects have also been reported
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:
Less common
Bladder pain
bloating or swelling of the face, arms, hands, lower legs, or feet
bloody or cloudy urine
blurred vision
cough producing mucus
difficult, burning, or painful urination
difficulty breathing
dizziness
frequent urge to urinate
headache
loss of appetite
lower back or side pain
mouth or throat pain
nervousness
pale skin
pounding in the ears
rapid weight gain
slow or fast heartbeat
stomach pain
tightness in the chest
tingling of the hands or feet
trouble breathing
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
Rare
Breakdown or tearing of the skin
chills
irregular heartbeat, recurrent
irritation, itching, pain, redness, swelling, tenderness, or warmth on the skin
unusual drowsiness, dullness, or feeling of sluggishness
Incidence not known
Agitation
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
blurred vision
confusion
darkening of the skin
difficulty swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
headache, severe and throbbing
hives, skin rash
irregular, fast, slow, or shallow breathing
mental depression
overactive reflexes
pale or blue lips, fingernails, or skin
pinpoint pupils
poor coordination
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
relaxed and calm feeling
restlessness
shivering
sleepiness
talking or acting with excitement you cannot control
trembling or shaking
twitching
vomiting
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Change in consciousness
cold and clammy skin
increased sweating
coughing that sometimes produces a pink frothy sputum
difficult or trouble breathing
increased sweating
irregular, fast or slow, or shallow breathing
loss of consciousness
pale or blue lips, fingernails, or skin
sleepiness or unusual drowsiness
swelling in legs and ankles
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
Back pain
chills
difficulty having a bowel movement
hoarseness
painful or difficult urination
trouble sleeping
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.
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Pros and cons of Buprenorphine
Pros
- Helps reduce opioid cravings and ease withdrawal symptoms
- Dose is personalized to your needs
Cons
- Must dissolve under the tongue
- Is a controlled substance because it has a risk of misuse and dependence
Pharmacist tips for Buprenorphine
- Take your first dose of buprenorphine exactly as your prescriber tells you. If you take it too soon after using opioids, it can cause withdrawal symptoms. Your prescriber will adjust your dose during the first few days to find the dose that's right for you. Follow their instructions carefully.
- Don't stop taking buprenorphine or change your dose without talking to your prescriber first. If it's the right choice, they'll lower your dose slowly. This helps prevent withdrawal symptoms, like nausea, muscle aches, and irritability.
- Keep naloxone (Narcan) with you in case of an opioid overdose. Ask your prescriber or pharmacist how to get naloxone. It's important that you and everyone close to you knows how to use it.
- Tell your prescriber about all the medications you take or plan to take. Some can interact with buprenorphine. For example, benzodiazepines and sedatives can raise your risk of serious side effects, like extreme sleepiness or slowed breathing. Your prescriber can make sure your medications are safe to take together.
- Tell your prescribers if you need treatment for pain while taking buprenorphine. They might recommend trying a non-opioid pain medication first. Don't take an opioid pain medication unless your prescriber tells you it's safe. This can raise your risk of serious side effects, like slowed breathing.
- If you're pregnant or planning to become pregnant: Talk to your prescriber. They can explain the risks and benefits of taking buprenorphine during pregnancy. Treating opioid use disorder during pregnancy is important for your health and your baby's health. At the same time, babies exposed to buprenorphine during pregnancy can have withdrawal symptoms after birth, though it's treatable.
- If you plan to breastfeed: Talk to your prescriber. They can help you decide if breastfeeding while taking buprenorphine is right for you and your baby.
- Store buprenorphine in a safe place where children, visitors, and pets can't reach it. When you no longer need the medication, use a take-back program if one is available. If not, you can flush it down the toilet.
How to take buprenorphine tablet:
- Place the tablet under your tongue and let it dissolve completely. Don't cut, chew, or swallow the tablet whole. This can affect the way the medication works in your body.
- Let the tablet dissolve completely before you talk, eat, or drink. This helps you get the full dose of medication.
- After the tablets dissolve, gently swish water around your mouth and swallow it. Wait at least 1 hour before brushing your teeth. This can help prevent tooth damage.
- If your full dose is more than one tablet, you can place them all under your tongue at once. If they don't fit comfortably, place two tablets under your tongue at a time.
Buprenorphine dosage
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2mg | 60 sublingual tablets | $31.89 | $0.53 |
| 8mg | 90 sublingual tablets | $53.27 | $0.59 |
Typical dosage for Buprenorphine
Place the buprenorphine tablet under your tongue and let it dissolve. When you first start treatment (called induction), your prescriber will adjust your dose over the first few days. Follow your prescriber's instructions carefully on how often to take the medication.
Your buprenorphine dose is personalized. Your prescriber will choose the right dose based on several factors, including:
- The type of opioid you were taking
- When you last used an opioid
- How severe your opioid dependence is
Buprenorphine tablets are often used during induction before switching to a maintenance treatment. Some people continue taking buprenorphine tablets once a day as their maintenance treatment, depending on their individual needs.
More on Buprenorphine dosage
Interactions between Buprenorphine and other drugs
More on Buprenorphine interactions
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 this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Cisapride
- Dronedarone
- Fluconazole
- Ketoconazole
- Mesoridazine
- Nalmefene
- Naltrexone
- Pimozide
- Piperaquine
- Posaconazole
- Safinamide
- Saquinavir
- Sparfloxacin
- Terfenadine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Acepromazine
- Alfentanil
- Alfuzosin
- Almotriptan
- Alprazolam
- Amineptine
- Amiodarone
- Amisulpride
- Amitriptyline
- Amitriptylinoxide
- Amobarbital
- Amoxapine
- Amphetamine
- Amprenavir
- Anagrelide
- Apomorphine
- Aprepitant
- Aripiprazole
- Aripiprazole Lauroxil
- Armodafinil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Atazanavir
- Azithromycin
- Baclofen
- Bedaquiline
- Benperidol
- Benzhydrocodone
- Benzphetamine
- Boceprevir
- Bosentan
- Bromazepam
- Bromopride
- Brompheniramine
- 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
- Darunavir
- Dasatinib
- Degarelix
- Delamanid
- Delavirdine
- Desipramine
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexamethasone
- Dexmedetomidine
- Dextroamphetamine
- Dextromethorphan
- Dezocine
- 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
- Fingolimod
- Flecainide
- Flibanserin
- 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
- Moclobemide
- Modafinil
- Molindone
- Moricizine
- Morphine
- Moxifloxacin
- Nafarelin
- Nafcillin
- Nalbuphine
- 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
- 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
- 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
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