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.
Drug facts
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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.
Side effects of Suboxone tablets (buprenorphine / naloxone)
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 (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%)
Less Common 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
Suboxone tablets (buprenorphine / naloxone) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
More on Suboxone tablets (buprenorphine / naloxone) side effects
The following Suboxone tablets (buprenorphine / naloxone) 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 these to your care team if they continue or are bothersome):
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Headache
- Nausea
- Vomiting
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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.
How to take Suboxone tablets (buprenorphine / naloxone):
- 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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Common questions about Buprenorphine/Naloxone
Suboxone is a combination medication that contains buprenorphine and naloxone. Buprenorphine attaches to opioid receptors in the brain like other opioids do, but it doesn't turn the receptors on as strongly. This helps lessen the severity of withdrawal symptoms and lessen cravings in people with opioid use disorder (OUD) without causing the same "high" as other opioids. Naloxone blocks the actions of buprenorphine if Buprenorphine/Naloxone get misused by injection into the veins or by other ways.
Buprenorphine, which is the main ingredient in Suboxone that helps with withdrawal symptoms, typically starts to kick in within 30 to 45 minutes. But it can take up to a few hours before you feel the maximum effects of the medication.
The effects of buprenorphine typically last for 6 to 12 hours at doses less than 4 mg or about 1 to 3 days at doses higher than 16 mg. Buprenorphine is the ingredient in Buprenorphine/Naloxone that helps lessen the severity of withdrawal symptoms and lessen cravings. Talk to your prescriber if you have concerns about how long the effects of Buprenorphine/Naloxone last for you.
Yes. The term "narcotic" refers to opioid medications. Suboxone is a combination medication that contains buprenorphine, a partial opioid agonist, as one of its ingredients. Because of this, Buprenorphine/Naloxone can be considered as a narcotic.
Yes. Even though Buprenorphine/Naloxone are used to treat opioid use disorder (OUD), they still have a risk for addiction if it's misused. This is because Suboxone contains buprenorphine, which is an opioid. In general, opioids can become habit forming. Signs of addiction can include cravings to take the medication, continued use even though you have negative consequences from it, and possible withdrawal symptoms when you suddenly stop taking it. Take Buprenorphine/Naloxone exactly as prescribed to lower the risk for addiction. Your prescriber will work with you to find the lowest dose needed to manage your OUD and treat you for the shortest period of time possible.
Yes, Suboxone is a schedule III controlled substance because it has the opioid buprenorphine in it. Opioids like buprenorphine have a risk for misuse and physical dependence. Misuse is when a medication is used for non-medical reasons for certain desirable physical or emotional effects (e.g., a "high" feeling). People can also misuse the medication when they take it in a different way than prescribed (e.g., a higher dose). Dependence is when you start to rely on a medication and have withdrawal symptoms (like anxiety and muscle aches) if you stop taking it suddenly. Only take Buprenorphine/Naloxone as instructed by your prescriber to help lower the risk for misuse and dependency. Speak with your prescriber if you have any questions or concerns about these risks.
Yes, it's possible to overdose on Buprenorphine/Naloxone. Signs of an overdose include extreme sleepiness, slow heartbeat, and slowed breathing. For your safety, it's important to take Buprenorphine/Naloxone exactly as prescribed. Never change how much you take without talking to your prescriber first. Speak with your prescriber if you're concerned about the risk for overdose.
It's possible for Buprenorphine/Naloxone to make you tired. Keep in mind that some people who took the medication also reported having trouble sleeping. Pay attention to how Buprenorphine/Naloxone affect your sleep and talk to your prescriber about the best time of day to take your dose. They might recommend adjusting when you take the medication (either every morning or every night) depending on how it's affecting your sleep.
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Suboxone tablets (buprenorphine / naloxone) dosage
Typical dosage 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.
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Suboxone tablets (buprenorphine / naloxone) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Suboxone tablets (buprenorphine / naloxone) will not be safe for you to take.
- Severe allergy to buprenorphine or naloxone
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