buprenorphine
Buprenorphine is used as medication-assisted treatment for opioid use disorder. It's usually used along with counseling and social and emotional support. Typically, the medication is only used short term in the induction phase of treatment. But, some people might need to use it for a longer period of time. The buprenorphine sublingual tablet dissolves in the mouth when it's placed under the tongue. Common side effects include headache, difficulty sleeping, and nausea. It's a schedule III controlled medication because it has a risk of physical dependence and misuse.
What is Buprenorphine?
What is Buprenorphine used for?
- Opioid use disorder in adults (in addition to counseling and therapy programs)
How Buprenorphine works
Buprenorphine is a partial opioid agonist. It works by attaching to certain proteins called mu-opioid receptors in your brain just like other opioid medications do. But buprenorphine doesn't turn on these receptors as strongly as other opioids. This helps ease opioid cravings and lessens the risk for withdrawal symptoms in someone with opioid use disorder without causing the same "high" as other opioid medications.
Drug facts
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.
Potential for addiction and misuse
- Risk factors: History of alcohol or substance use disorder | Taking more buprenorphine than prescribed
Buprenorphine is a schedule III controlled substance that has a risk for addiction and misuse. Misusing this medication might make it not work as well. It can also raise the risk for serious side effects, such as dangerously slow breathing and the inability to stay awake. Take buprenorphine exactly as prescribed. Don't change the dose or how often you take it without talking to your provider first.
Dangerously slow breathing (respiratory depression)
- Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Medical conditions that cause breathing problems (e.g., COPD, asthma)
Buprenorphine can cause dangerously slow breathing, which can be life-threatening. Your risk is higher if you take other medications that can slow your body down (e.g., benzodiazepines, opioids), drink alcohol, or have breathing problems (e.g., COPD, asthma). People getting treatment for opioid use disorder can sometimes relapse, which puts them at high risk of breathing problems from opioid use. Your provider might recommend that you carry naloxone (Narcan) with you at all times in case you need to quickly treat these breathing issues. It's important for you and your loved ones know how to use naloxone (Narcan) in case you have extremely slowed breathing. Give naloxone (Narcan) and call 911 for medical help right away if you have trouble breathing or have bluish-colored lips, fingers, or toes.
Harm to newborns when taken during pregnancy
- Risk factors: Taking buprenorphine long term during pregnancy
If you take buprenorphine during pregnancy, you can pass the medication to your unborn baby. Long-term use during pregnancy can cause your unborn baby to become dependent on the medication and cause withdrawal symptoms after birth. Symptoms of withdrawal in your newborn can include high-pitched crying, poor feeding and sucking behavior, and seizures. This condition can be life-threatening if not recognized and treated in time. Make sure to tell your provider if you've taken buprenorphine during pregnancy. Specialized providers will know how to treat your newborn and make sure your baby gets the care they need once they're born.
Low adrenal hormone levels
- Risk factors: Taking buprenorphine for longer than 1 month
Some people taking opioids experienced a drop in their adrenal hormone levels, especially if they took the medication for longer than 1 month. This side effect might be less likely with buprenorphine if it's used for treatment for a short period of time. Let your provider know right away if you experience symptoms of low adrenal hormones, including nausea, vomiting, not feeling hungry, tiredness, dizziness, and weakness. Your provider might need to stop buprenorphine and treat you with corticosteroids.
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 taking buprenorphine have developed liver damage that's sometimes serious. The risk of harm might be higher if you already have liver problems. Your provider might recommend that you get blood tests before starting buprenorphine and periodically during treatment to make sure your liver is healthy. If you have liver damage, your provider might lower your dose of buprenorphine to prevent side effects. Let your provider know if you experience symptoms of liver problems, such as feeling tired, nausea, dark urine, pale stool, and yellowing of the whites of the eyes and skin.
Not for use for pain or in people who haven't taken opioids before
There have been reports of deaths from people who haven't taken opioids before and took a buprenorphine for pain. Buprenorphine is only for people who are currently taking opioids. It's also not meant to be used as a pain reliever.
Dental (teeth) problems
Some people who took buprenorphine that's dissolved in the mouth have had dental problems. These problems have included cavities, infections, damaged teeth, and even tooth loss. Make sure you have regular cleanings and check-ups with your dentist. Practice good oral hygiene, and regularly brush your teeth and floss every day. After each dose is dissolved, swish some water around your mouth and then swallow. Make sure to wait at least 1 hour after taking buprenorphine before brushing your teeth.
Life-threatening heart rhythm problems (QT prolongation)
- Risk factors: Heartbeat or heart rhythm problems | Electrolyte levels that aren't balanced in the body
Buprenorphine can cause QT prolongation, a potentially life-threatening heart rhythm problem. Your risk for these problems is higher if you already have heart problems or abnormal electrolyte levels in your body. Make sure to tell your provider about your full medical history before you start taking buprenorphine. Contact your provider if you feel symptoms of heart problems, such as pounding chest, trouble breathing, feeling faint or lightheaded, or chest pain, while taking buprenorphine.
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%)
- Difficulty sleeping (21%)
- General pain (18%)
- Opioid withdrawal symptoms (18%)
- Nausea (14%)
- Sweating (13%)
- Stomach pain (12%)
- Infection (12%)
Less Common Side Effects
- Runny nose
- Vomiting
- Constipation
- Diarrhea
- Chills
- Lack of energy
- Changes in sensations in the mouth (e.g., loss of sensation, burning sensation, pain)
- Redness inside of the mouth
- Swelling in the arms, legs, or ankles
Buprenorphine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Opioid withdrawal: suicidal thoughts, anxiety, restlessness, muscle or joint aches, runny nose, yawning, sweating, chills, irritability
- Dangerously slow breathing: trouble breathing; bluish-colored lips, fingers, or toes
- Heart rhythm problems: chest pounding, fluttering in the chest, difficulty breathing, chest pain, feeling faint or lightheaded
- Serious allergic reaction: rash; hives; shortness of breath; fast heartbeat; dizziness; flushing (feeling warm suddenly); swelling of 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
- Works well to treat opioid use disorder when used with counseling and other therapy programs
- Taken once per day
- Easy to take since tablets are dissolved under the tongue
- Dose can be adjusted based on response
- Available as a lower-cost generic
Cons
- Has a lot of potential risks and side effects, such as breathing problems and sleepiness
- Can't stop the medication suddenly because of possible withdrawal symptoms
- Risk of misuse and dependence
- Is a controlled substance, so there are special requirements to getting a prescription filled
- Hasn't been studied in children under 18 years old
Pharmacist tips for Buprenorphine
- Place buprenorphine under your tongue, and let it dissolve. Don't swallow the tablet whole since it won't work as well if you do.
- After the tablet is completely dissolved, rinse your mouth with water and swallow. Don't brush your teeth for at least one hour after taking your dose to avoid damage to your teeth.
- If you miss your dose of buprenorphine, take it as soon as you remember. But if it's almost time for your next dose, skip the missed tablet and just take your dose at your regular time. Call your provider if you have questions.
- Before starting buprenorphine and during treatment, tell your provider about all of the medications you're taking. Taking buprenorphine together with benzodiazepines, sedatives, or alcohol can worsen side effects (e.g., slow breathing rate, severe sleepiness), which can be life-threatening.
- If you need to take pain medications for whatever reason, make sure to let your provider know that you're already taking buprenorphine. It's best to start with non-opioid medications first to relieve pain. Taking another opioid medication with buprenorphine can put you at risk for serious side effects, such as sleepiness and breathing problems. If you need opioid therapy, you'll only be able to receive care under a provider's supervision.
- Buprenorphine can make you very sleepy, which can affect your ability to focus, think, or react. Don't drive or do anything requiring your full attention until you know how this medication affects you. In particular, be careful during the first few days following treatment or a change in your dose.
- Don't stop taking buprenorphine without talking to your provider first. They'll need to lower your dose slowly before stopping it completely so you don't get any withdrawal symptoms (e.g., shaking, runny nose, vomiting, sweating, chills, diarrhea, muscle aches).
- Store buprenorphine securely so that it can't be accidentally misused or taken by others. Make sure to keep it out of reach of children for their safety. When you no longer need buprenorphine, you can flush it down the toilet or give it to a drug take-back program if there's one near you.
Common questions about Buprenorphine
This formulation of buprenorphine is a sublingual tablet that's placed under your tongue until it completely dissolves. If your dose requires you to use more than one tablet, you can place all the tablets at once under your tongue. If all of the tablets don't fit at once, place two tablets under your tongue at a time. After the tablet(s) has dissolved, swish some water gently in your mouth around your teeth and gums, and swallow. Wait at least 1 hour after taking buprenorphine before brushing your teeth. Never cut, chew, or swallow the tablet whole because doing so can affect the way it works in your body.
Yes, buprenorphine is a schedule III controlled substance because it has a high risk of physical dependence and misuse. 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 even though it's not prescribed for them or when they take a higher than recommended dose. Dependence is when you rely on a medication to function normally and experience withdrawal symptoms if you stop taking it suddenly. These withdrawal symptoms can include restlessness, muscle aches, and trouble sleeping. To help lower these risks, only take buprenorphine as prescribed by your provider. Follow your provider's instructions to slowly lower the dose before completely stopping the medication. If you have any questions or concerns, speak with your provider.
Even though buprenorphine is used to treat opioid use disorder, it itself also has the risk for addiction. This is because buprenorphine is a type of opioid medication, and opioids are known to have a risk for addiction. Make sure you only use this medication as prescribed by your provider. If you have any questions or concerns, talk with your provider.
It takes about 7 to 8 days for the majority of the buprenorphine sublingual tablet to leave your body. But if you have severe liver problems, it can take even longer. Keep in mind that this time frame is an estimate that's based on the half-life of buprenorphine when it's dissolved under the tongue. What's more, the time frame can also depend on your age, health conditions, and genetics. Because of this, the time it takes for the medication to leave the body can be different for everyone. Speak with your provider if you have questions about how long the buprenorphine stays in your body.
When you first start buprenorphine, your provider will probably have you take your doses under their supervision at a clinic or office. Once your symptoms are under control and you're comfortable taking buprenorphine by yourself, your provider will determine if it's safe for you to take your doses at home.
There are several forms of buprenorphine that are currently available on the market. Some brands are used only for pain (e.g., Belbuca, Butrans, Buprenex). Other brands are only used for opioid use disorder (e.g., Subutex, Zubsolv, Suboxone). There are two main differences among the buprenorphine products used for opioid use disorder. They differ in how they're given (sublingual tablet or injection). Some brands are also formulated with naloxone, while others aren't. Talk to your provider about which buprenorphine formulation is right for you.
Study results aren't clear enough to show whether or not buprenorphine can cause birth defects if used by mothers during pregnancy. But it's possible for babies born to mothers who use buprenorphine during pregnancy to experience withdrawal symptoms after birth. These symptoms can include high-pitched crying, poor feeding and sucking behavior, and seizures. If you're pregnant or thinking of becoming pregnant, talk with your provider about the benefits and risks of using buprenorphine or other medications containing buprenorphine during pregnancy.
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Buprenorphine dosage
Sublingual tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2mg | 60 sublingual tablets | $27.81 | $0.46 |
| 8mg | 60 sublingual tablets | $55.36 | $0.92 |
Typical dosage for Buprenorphine
The dose of buprenorphine for induction treatment (the beginning of treatment) and maintenance treatment is different for everyone. Dosing depends on several factors, including:
- The type of opioid dependence (whether you were taking a long-acting or short-acting opioid)
- The last time an opioid was used
- Severity of opioid dependence
The typical buprenorphine dose ranges from 2 mg to 24 mg dissolved under the tongue once daily. Your provider will determine the dose that's safe and works well for you.
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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