What is Suboxone?
Suboxone (buprenorphine/naloxone) is a brand-name prescription drug. It’s used to treat dependence on opioid drugs.
Suboxone comes as an oral film that’s placed under your tongue (sublingual) or between your gums and cheek (buccal). The film dissolves in your mouth.
Suboxone contains two drugs in each film: buprenorphine and naloxone. It’s available in four strengths:
- 2 mg buprenorphine / 0.5 mg naloxone
- 4 mg buprenorphine / 1 mg naloxone
- 8 mg buprenorphine / 2 mg naloxone
- 12 mg buprenorphine / 3 mg naloxone
Studies show that Suboxone is effective for reducing opioid misuse. It’s also effective for keeping people with opioid dependence in treatment over a period of 24 weeks. (How well a drug such as Suboxone performs is partly assessed based on how long people stay in treatment.)
Is Suboxone a controlled substance?
Yes, Suboxone is a controlled substance. It’s classified as a schedule three (III) prescription drug. This means that it has an accepted medical use, but it may cause physical or psychological dependence and may be abused.
The government has created special rules for how schedule III drugs can be prescribed by a doctor and dispensed by a pharmacist. Your doctor or pharmacist can tell you more.
Doctors can only prescribe this drug for opioid dependence after receiving special training and certification through the U.S. federal government.
Suboxone generic
Suboxone is a brand-name drug that contains two ingredients: buprenorphine and naloxone.
Suboxone is also available in a generic version. The generic version comes in two forms: an oral film and an oral tablet. Both the film and the tablet are sublingual forms, which means you place them under your tongue to dissolve. The film can also be placed between your gums and cheek to dissolve (buccal).
Suboxone side effects
Suboxone can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Suboxone. This list does not include all possible side effects.
For more information on the possible side effects of Suboxone, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.
More common side effects
The more common side effects of Suboxone include:
Some of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.
Serious side effects
Serious side effects from Suboxone aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.
Serious side effects can include the following:
- severe allergic reaction
- abuse and dependence
- breathing problems
- coma
- hormone problems (adrenal insufficiency)
- liver damage
- severe withdrawal symptoms
See below for information about each serious side effect.
Severe allergic reaction
Serious allergic reactions including anaphylaxis can occur in some people who take Suboxone. Symptoms of an allergic reaction can include:
- trouble breathing
- skin rash or hives
- swelling of the lips, tongue, throat
If you have an allergic reaction to this drug, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.
Abuse and dependence
Suboxone has opioid effects, and long-term use can lead to physical and psychological dependence. Suboxone dependence can cause drug-craving and drug-seeking behavior, which may lead to misuse or abuse.
Abuse can cause overdose and dangerous side effects, including death. This is especially true if Suboxone is used along with other opioids, alcohol, benzodiazepines (such as Ativan, Valium, or Xanax), or other drugs.
If you’re physically dependent on Suboxone and abruptly stop taking it, you could have mild withdrawal symptoms, such as nausea, headache, and muscle aches. These symptoms can be avoided by slowly tapering the dose of the medication before completely stopping.
Breathing problems and coma
Taking high doses of Suboxone can cause severe breathing problems, coma, and death.
These effects are more likely to occur when Suboxone is misused or abused. They’re also more likely when Suboxone is used together with other drugs such as opioids, alcohol, or benzodiazepines (such as Ativan, Valium, or Xanax).
Breathing problems are also more likely to occur in people who already have a breathing problem, such as chronic obstructive pulmonary disease (COPD).
Hormone problems
Some people who take opioids such as Suboxone for several weeks can have reduced cortisol hormone levels. This condition is called adrenal insufficiency. Symptoms can include:
Liver damage
Both mild and severe liver damage has occurred in people taking Suboxone. In some cases, this may have been due to a hepatitis infection or other causes. However, in other cases, Suboxone may have been the cause.
During your treatment with Suboxone, your doctor may do blood tests to check your liver function. If you have symptoms of liver damage, you may need to stop taking Suboxone. Symptoms of liver damage can include:
- stomach pain
- fatigue
- yellowing of your skin or the whites of your eyes
Severe withdrawal symptoms
Suboxone contains naloxone. It’s included in Suboxone solely to help prevent abuse of the medication. Because of this ingredient, you could have severe withdrawal symptoms if you abuse Suboxone.
Naloxone is an opioid antagonist, which means it blocks the effects of opioid drugs. If you’re dependent on other opioids and you use Suboxone as an injection to shoot up, it will block the effects of any opioids in your system. This could lead to immediate opioid withdrawal symptoms.
But using the Suboxone film in your cheek or under your tongue won’t cause these severe withdrawal symptoms. That’s because the film doesn’t release as much naloxone into your system.
However, using the film could cause withdrawal symptoms if it’s taken while you still have other opioids in your system. That’s why it’s meant to be used only after the effects of opioids begin to wear off and you start to have withdrawal symptoms.
Avoiding withdrawal symptoms
Suboxone should only be used with short-acting opioids. This is because use with long-acting opioids will cause increased withdrawal symptoms. Short-acting opioids include heroin, codeine, morphine, and oxycodone (Roxicodone, RoxyBond).
Also, when used for induction treatment (see “How Suboxone works” below), Suboxone should be used under your tongue rather than in your cheek. When you use Suboxone film in your cheek, your body absorbs more naloxone, and withdrawal symptoms are more likely.
Long-term side effects
Suboxone is often used long-term for maintenance treatment of opioid dependence. Long-term use of Suboxone may increase the risk of certain side effects, such as:
- hormone problems such as adrenal insufficiency
- liver damage
- abuse and dependence
Taking any opioid medication long-term, including Suboxone, can cause physical dependence. But long-term use of Suboxone can make it easier to stop abusing other opioids by reducing severe withdrawal and drug cravings.
When it comes time to stop taking Suboxone, your doctor will have you slowly taper off the medication to prevent withdrawal.
Constipation
Constipation is a common side effect of Suboxone. In one study, constipation occurred in about 12 percent of people taking Suboxone. If this side effect doesn’t go away or becomes severe, talk with your doctor. Your doctor may recommend treatment to relieve and prevent constipation.
Headache
Headache is a common side effect of Suboxone. In one study, headache occurred in about 36 percent of people taking Suboxone. This side effect may go away with continued use of the drug.
Weight loss or weight gain
Weight gain or weight loss are not side effects that have been reported in studies of Suboxone. However, some people who take Suboxone have reported having weight gain. It’s not known if Suboxone was the cause.
Rash
Rash is not a common side effect of Suboxone. However, some people who take Suboxone may get a rash if they have an allergic reaction to the drug. The most common symptoms of an allergic reaction to Suboxone are rash or hives and itchy skin.
If you have a rash while taking Suboxone, talk with your doctor. You may need a different treatment. (If you also have other symptoms, such as swelling of your face or trouble breathing, call your doctor or local poison control center right away. This could be a serious allergic reaction. If your symptoms are severe, call 911 or go to the nearest emergency room.)
Sweating
Sweating is a common side effect of Suboxone. In a study, sweating occurred in about 14 percent of people taking Suboxone. This side effect may go away with continued use of the drug.
Hair loss
Hair loss is not a side effect that has been reported in studies of Suboxone. However, some people who take Suboxone have reported having hair loss. It’s not known if Suboxone was the cause.
Insomnia
Insomnia (trouble sleeping) is a common side effect of Suboxone. In one study, insomnia occurred in about 14 percent of people taking Suboxone. This side effect may go away with continued use of the drug.
Driving problems
Suboxone can impair your ability to drive. If you feel lightheaded or sleepy after taking it, don’t drive. Also, don’t use dangerous equipment.
Brain damage
Brain damage is not a side effect that has been reported in people taking Suboxone.
Suboxone uses
The Food and Drug Administration (FDA) approves prescription drugs such as Suboxone to treat certain conditions. Suboxone may also be used off-label for other conditions.
Suboxone for opioid dependence
Suboxone is FDA-approved to treat opioid dependence. According to the American Society of Addiction Medicine, Suboxone is a recommended treatment for opioid dependence. It helps treat opioid dependence by reducing the withdrawal symptoms that can occur when opioid use is stopped or reduced.
Suboxone for withdrawal
Suboxone is sometimes used off-label to help manage opioid withdrawal symptoms as part of a detoxification program. It may help reduce how severe symptoms are.
Detoxification programs are generally short-term, inpatient treatment plans used to wean people off of drugs, such as opioids, or alcohol.
Opioid dependence treatment, on the other hand, is a longer-term approach to reducing dependence on opioids, with most of the treatment being done on an outpatient basis.
Suboxone for pain
Suboxone is sometimes used off-label for treating pain. However, this use is controversial, because it’s not clear how well, or if, Suboxone works to treat pain. Suboxone may be beneficial for people who have both chronic pain and opioid dependence.
Buprenorphine, one of the drugs contained in Suboxone, is also used for pain. However, studies of how effective it is for this purpose are mixed.
Suboxone for depression
Suboxone is not used for treating depression. However, buprenorphine, one of the drugs contained in Suboxone, is sometimes used to treat depression and treatment-resistant depression. Some research shows that buprenorphine may improve mood in people with depression.
How Suboxone works
Suboxone contains two ingredients: buprenorphine and naloxone.
Buprenorphine’s role
Buprenorphine has some of the same effects as opioid drugs, but it also blocks other effects of opioids. Because of these unique effects, it’s called an opioid partial agonist-antagonist.
Buprenorphine is the part of Suboxone that helps treat opioid drug dependence. It does this by reducing withdrawal symptoms and drug cravings. And because it’s an opioid partial agonist-antagonist, it’s less likely to cause a high than an opioid.
Naloxone’s role
Naloxone is included in Suboxone solely to help prevent abuse of the medication. Naloxone is classified as an opioid antagonist. This means it blocks the effects of opioid drugs.
If you’re dependent on opioids and inject Suboxone, the naloxone can cause dangerous withdrawal symptoms. This is because it blocks the effects of opioids, putting you into immediate withdrawal.
However, this withdrawal is less likely to occur when you use the Suboxone film. This is because the film releases less naloxone into your body than an injection does.
Phases of treatment
Treatment of opioid dependence occurs in two phases: induction and maintenance. Suboxone is used in both of these phases.
During the induction phase, Suboxone is used to reduce withdrawal symptoms when opioid use is being decreased or stopped. Suboxone is only used for induction in people who are dependent on short-acting opioids. These opioids include heroin, codeine, morphine, and oxycodone (Roxicodone, RoxyBond).
Suboxone should only be used when the effects of these opioids have begun to wear off and withdrawal symptoms have started.
During the maintenance phase, Suboxone is used at a stable dosage for an extended period. The purpose of the maintenance phase is to keep withdrawal symptoms and cravings in check as you go through your drug abuse or addiction treatment program.
After several months to a year or longer, your doctor may stop your Suboxone treatment using a slow dosage taper.
Suboxone withdrawal
Long-term use of Suboxone can cause physical and psychological dependence. Physical dependence can cause mild withdrawal symptoms if Suboxone use is abruptly stopped. To help prevent these symptoms, if you’ll be stopping use of Suboxone, your dosage should be slowly tapered with the help of your doctor.
Examples of Suboxone withdrawal symptoms include:
- nausea
- diarrhea
- headache
- muscle aches
- insomnia (trouble sleeping)
- anxiety
- irritability
- drug cravings
- sweating
Suboxone dosage
The Suboxone dosage your doctor prescribes will depend on several factors. These include:
- the type and severity of opioid dependence
- the stage of treatment you’re in
- other medical conditions you may have
Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.
Drug forms and strengths
Suboxone is only available as an oral film that can be placed under the tongue (sublingual) or in the cheek (buccal). It comes in four strengths:
- 2 mg buprenorphine / 0.5 mg naloxone
- 4 mg buprenorphine / 1 mg naloxone
- 8 mg buprenorphine / 2 mg naloxone
- 12 mg buprenorphine / 3 mg naloxone
Suboxone is also available as a generic version that comes in other forms. These forms include a sublingual film and a sublingual tablet.
Other drug forms
Suboxone contains two drugs: buprenorphine and naloxone. These individual drugs come in additional forms. Buprenorphine forms include a sublingual tablet, a skin patch, an implant for under the skin, and a solution for injection. Naloxone forms include a nasal spray and a solution for injection. (These forms of the two drugs are not all used to treat opioid dependence.)
Dosage for opioid dependence
Suboxone is FDA-approved to treat opioid dependence. Treatment of opioid dependence occurs in two phases: induction and maintenance.
During the induction phase (see “How Suboxone works” above), Suboxone is used to reduce withdrawal symptoms when opioid use is being decreased or stopped. During the maintenance phase, Suboxone is continued at a stable dose for a time ranging from several months to over a year.
Below are examples of how your induction and maintenance dosages may be administered.
Induction dosage
- Induction details
- Induction treatment with Suboxone takes place in your doctor’s office or clinic.
- Suboxone is only used for induction treatment if you’re dependent on short-acting opioids such as heroin, codeine, morphine, or oxycodone (Roxicodone, RoxyBond).
- You should use Suboxone oral film under your tongue during induction treatment. Don’t use it in your cheek because this is more likely to cause withdrawal symptoms.
- Suboxone induction shouldn’t start until:
- at least six hours after your last use of a short-acting opioid
- you start to have moderate opioid withdrawal symptoms
- On day 1:
- In your doctor’s office, your doctor will start you on a low Suboxone dose. This dose might be 2 mg buprenorphine / 0.5 mg naloxone or 4 mg buprenorphine / 1 mg naloxone.
- Your doctor will evaluate your withdrawal symptoms for about two hours. If needed, they’ll give you another dose of Suboxone.
- The maximum total dose on the first day is 8 mg buprenorphine / 2 mg naloxone.
- On day 2:
- Your doctor will evaluate your withdrawal symptoms. If your symptoms are controlled, your doctor will give you the same total dose you received on day 1. If your symptoms are not controlled, your doctor will give you what you received on day 1, plus an additional amount of 2 mg buprenorphine / 0.5 mg naloxone or 4 mg buprenorphine / 1 mg naloxone.
- Your doctor will evaluate your symptoms again in about two hours. If needed, they’ll give you another dose of Suboxone.
- Additional days:
- This stepwise process may continue for additional days until your withdrawal symptoms are controlled and stabilized for two or more days. During induction, your Suboxone dose may be increased to a maximum of 32 mg buprenorphine / 8 mg naloxone once daily.
Maintenance dosage
- Maintenance details:
- When you reach a Suboxone dose that keeps you stable, your treatment will be continued with this dose during the maintenance phase.
- During this phase, you can use Suboxone oral film under your tongue or in your cheek.
- The length of your maintenance treatment will depend on your needs and goals. It may last from a few weeks or months, to more than a year.
- During this time, you may have weekly or monthly appointments with your doctor.
- If you continue to use opioids during the maintenance phase, or if you misuse Suboxone, your doctor may recommend a different treatment program for you.
- Suboxone taper:
- You and your doctor will decide together when it might be the right time to end your treatment with Suboxone.
- When the decision is made to stop Suboxone, your dosage of the medication will be slowly decreased over time. This tapering off of your dosage may take several weeks or months.
- If your withdrawal symptoms or cravings return during the taper, your doctor may temporarily increase your dosage.
- Maximum dosage: The maximum daily dose during the maintenance phase is 32 mg buprenorphine / 8 mg naloxone.
What if I miss a dose?
If you miss a dose during the maintenance phase, take it as soon as you remember. If it’s almost time for your next dose, just take that one dose. Don’t try to catch up by taking two doses at once.
Will I need to use this drug long-term?
Yes, when Suboxone is used to treat opioid dependence, it’s often used long-term.
Does Suboxone use lead to tolerance?
When certain opioids are used long-term for treating pain or for a “high,” tolerance to those effects can happen over time. This means your body gets used to the drug and you need higher and higher doses to get the same effect.
Drug tolerance has not been seen with Suboxone or with either of the drugs it contains (buprenorphine or naloxone). When Suboxone is used long-term for opioid dependence, tolerance to the beneficial effects of Suboxone doesn’t occur.
Suboxone drug test
While taking Suboxone for opioid dependence, you may be required to do frequent drug tests for the use of opioids.
Urine test
There are different types of urine drug tests. Some of these tests, including the tests often used in those who take Suboxone for opioid dependence, can detect the presence of Suboxone and other opioid drugs.
Most opioids can be detected within one to three days after use. However, Suboxone is long-lasting. It may be detected for longer periods of time.
Home drug test
Most home urine drug tests check for opioids, but don’t usually test for the drugs contained in Suboxone. However, there are some home drug tests that do check for buprenorphine, one of the drugs in Suboxone. This, of course, means a positive result for buprenorphine is a positive result for Suboxone.
Suboxone abuse
Long-term use of Suboxone can lead to physical and psychological dependence. Suboxone dependence can cause drug-craving and drug-seeking behavior, which may lead to misuse or abuse.
Abuse can cause overdose and dangerous side effects, including death. This is especially true if Suboxone is used along with other opioids, alcohol, benzodiazepines (such as Ativan, Valium, or Xanax), or other drugs.
Suboxone overdose
Taking too much of this medication can increase your risk of severe side effects.
Overdose symptoms
Symptoms of an overdose of Suboxone can include:
- headache
- nausea
- vomiting
- diarrhea
- stomach pain or upset
- anxiety
- sweating
- chills
- weakness or fatigue
- dizziness
- decreased touch sensation
- burning tongue
- trouble breathing
- coma
- death
Overdose treatment
If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
Alternatives to Suboxone
There are a few other drugs in addition to Suboxone that are used to treat opioid dependence. Examples of these drugs include:
- methadone (Dolophine)
- naltrexone (Vivitrol)
- buprenorphine
There are also other medications that contain buprenorphine plus naloxone, the ingredients in Suboxone. The brand names for these other medications are Bunavail and Zubsolv.
Suboxone vs. other drugs
You may wonder how Suboxone compares to other drugs used to treat opioid dependence. Below are comparisons between Suboxone and several medications.
Suboxone vs. Subutex
Suboxone is a brand-name medication that contains two drugs: buprenorphine and naloxone.
Subutex was a brand-name drug that contained buprenorphine, one of the ingredients in Suboxone. Brand-name Subutex is no longer available. There are no brand-name forms of buprenorphine currently available for treating opioid dependence. (The ones that are available are used to treat pain.)
Uses
Suboxone and buprenorphine, the generic form of Subutex, are both FDA-approved for treating opioid dependence. This includes both the induction and maintenance phases of treatment.
During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse or addiction treatment program.
Forms and administration
Suboxone comes as an oral film that can be used under your tongue (sublingual) or in your cheek (buccal). Buprenorphine forms used for treating opioid dependence include an oral film, a sublingual tablet, and an implant for under the skin.
Effectiveness
In one study, Suboxone and buprenorphine were equally effective for reducing withdrawal symptoms during the induction phase (the first phase) of opioid dependence treatment.
In another study, starting induction treatment on day 1 with Suboxone was just as effective as starting with buprenorphine and then switching to Suboxone on day 3.
The Substance Abuse and Mental Health Services Administration generally recommends Suboxone rather than buprenorphine for both the induction and maintenance phases of opioid dependence treatment.
However, Suboxone is only appropriate for induction in people who are dependent on short-acting opioids such as heroin, codeine, morphine, or oxycodone (Roxicodone, RoxyBond).
Buprenorphine, on the other hand, is recommended for people who are dependent on long-acting opioids such as methadone.
Side effects and risks
Suboxone and buprenorphine are very similar drugs and cause similar common and serious side effects.
More common side effects
Examples of the more common side effects of Suboxone and buprenorphine include:
- headache
- opioid withdrawal symptoms, such as body aches, abdominal cramps, and rapid heart rate
- nausea
- vomiting
- stomach pain or upset
- diarrhea
- anxiety
- insomnia (trouble sleeping)
- sweating
- depression
- constipation
- chills
- weakness or fatigue
- dizziness
- cough
- fever
- runny nose
- sore throat
- back pain
Serious side effects
Examples of serious side effects shared by Suboxone and buprenorphine include:
- severe allergic reaction
- abuse and dependence
- breathing problems and coma
- hormone problems (adrenal insufficiency)
- liver damage
- severe withdrawal symptoms
Costs
Suboxone is a brand-name drug. It’s also available in a generic version. Generics are often less expensive than brand-name drugs.
The Subutex brand-name product is no longer available. It’s only available in its generic version, buprenorphine. There are no brand-name forms of buprenorphine available that are used to treat opioid dependence.
Buprenorphine and Suboxone cost about the same amount. However, the actual amount you pay will depend on your insurance.
Suboxone vs. methadone
Suboxone is a brand-name medication that contains two drugs: buprenorphine and naloxone. Methadone is a generic medication. It’s also available in a brand-name version called Dolophine.
Uses
Suboxone is FDA-approved to treat opioid dependence, including both the induction and maintenance treatment phases.
During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse treatment program.
Methadone is FDA-approved only for the maintenance phase of opioid dependence treatment. It’s used off-label for the induction phase of treatment. Methadone is also FDA-approved to treat moderate-to-severe pain.
In addition, methadone is approved for treatment during opioid detoxification. Detoxification programs are generally short-term, inpatient treatment plans used to wean people off of drugs such as opioids or alcohol. Opioid dependence treatment, on the other hand, is a longer-term approach to reducing dependence on opioids, with most of the treatment being done on an outpatient basis.
Forms and administration
Suboxone comes as an oral film that can be used under your tongue (sublingual) or between your gums and your cheek (buccal).
Methadone comes in several forms, including:
- oral tablet
- oral solution
- tablet for oral suspension
- solution for injection
Effectiveness
Suboxone and methadone have been compared in clinical studies evaluating their use for treating opioid dependence.
In a 2013 study, Suboxone and methadone were found to be equally effective for reducing the use of opioids and keeping users in their treatment program.
A 2014 study found that people taking Suboxone used opioids less compared to people taking methadone. However, the people taking methadone were more likely to stay in their treatment program.
An analysis of several studies found that overall, Suboxone was more effective for reducing the use of opioid drugs, but methadone was more effective for keeping users in their treatment program.
Side effects and risks
Suboxone and methadone have some similar side effects, and some that differ. Below are examples of these side effects.
| Suboxone and methadone | Suboxone | Methadone | |
| More common side effects |
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| Serious side effects |
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*Methadone has a boxed warning from the FDA. This is the strongest warning that the FDA requires. A boxed warning alerts doctors and patients about drug effects that may be dangerous.
Costs
Suboxone is a brand-name drug. It’s also available in a generic version. Generics are often less expensive than brand-name drugs.
Methadone is a generic drug. It’s also available as a brand-name version called Dolophine.
Methadone usually costs less than brand-name or generic Suboxone. However, the actual amount you pay will depend on your insurance.
Suboxone vs. Zubsolv
Both Suboxone and Zubsolv are brand-name medications that contain two drugs: buprenorphine and naloxone.
Uses
Both Suboxone and Zubsolv are FDA-approved to treat opioid dependence, including the induction and maintenance phases of treatment.
During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse treatment program.
Forms and administration
Suboxone comes as an oral film that can be used under your tongue (sublingual) or in your cheek (buccal).
Zubsolv comes as an oral tablet that’s used under your tongue.
Effectiveness
Suboxone and Zubsolv contain the same drugs and are used in the same way to treat opioid dependence. They’re expected to be equally effective. The decision to use Suboxone or Zubsolv is based on personal preference for use of the sublingual film or tablet.
Side effects and risks
Suboxone and Zubsolv contain the same drugs and cause similar common and serious side effects.
More common side effects
Examples of the more common side effects of Suboxone and Zubsolv include:
- headache
- opioid withdrawal symptoms, such as body aches, abdominal cramps, and rapid heart rate
- nausea
- vomiting
- constipation
- diarrhea
- stomach pain or upset
- anxiety
- insomnia (trouble sleeping)
- sweating
- depression
- chills
- weakness or fatigue
- dizziness
- cough
- fever
- runny nose
- sore throat
- back pain
Serious side effects
Examples of serious side effects shared by Suboxone and Zubsolv include:
- severe allergic reaction
- abuse and dependence
- breathing problems and coma
- hormone problems (adrenal insufficiency)
- liver damage
- severe withdrawal symptoms
Costs
Suboxone and Zubsolv are brand-name drugs. There’s a generic version of Suboxone film. There’s no generic version of Zubsolv sublingual tablets.
Zubsolv usually costs less than brand-name or generic Suboxone. However, the actual amount you pay will depend on your insurance.
Suboxone vs. Vivitrol
Suboxone is a brand-name medication that contains two drugs: buprenorphine and naloxone. Buprenorphine is classified as an opioid partial agonist-antagonist. This means it has some effects like opioid drugs, but it also blocks other opioid effects.
Naloxone is classified as an opioid antagonist. This means it blocks the effects of opioid drugs.
Vivitrol is a brand-name medication that contains the drug naltrexone. Naltrexone is an opioid antagonist, similar to the naloxone contained in Suboxone.
Uses
Suboxone is FDA-approved to treat opioid dependence. This includes two phases of treatment: induction and maintenance.
During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse treatment program.
Vivitrol is also approved to treat opioid dependence. However, it’s only approved for preventing relapse in people who have completely stopped abusing opioids.
Forms and administration
Suboxone comes as an oral film that can be used under your tongue (sublingual) or in your cheek (buccal).
Vivitrol comes as an extended-release injection that’s given in a doctor’s office or clinic.
Effectiveness
Suboxone and Vivitrol have been compared in clinical studies. These studies evaluated the drugs’ use for preventing relapse and maintaining abstinence from heroin or opioid use.
A 2017 study found that Vivitrol and Suboxone were equally effective for reducing opioid and heroin use over 12 weeks. A 2018 study found that Suboxone was more effective for preventing relapse and was easier to use than Vivitrol.
Side effects and risks
Suboxone and Vivitrol have some similar side effects, and some that differ. Below are examples of these side effects.
| Suboxone and Vivitrol | Suboxone | Vivitrol | |
| More common side effects |
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| Serious side effects |
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Costs
Suboxone and Vivitrol are brand-name drugs. There’s a generic version of Suboxone, but there’s no generic version of Vivitrol. Generic versions often cost less than brand-name drugs.
Vivitrol usually costs much more than brand-name or generic Suboxone. The actual amount you pay will depend on your insurance.
Suboxone vs. Bunavail
Both Suboxone and Bunavail are brand-name medications that contains two drugs: buprenorphine and naloxone.
Uses
Both Suboxone and Bunavail are FDA-approved to treat opioid dependence. This includes both the induction phase and the maintenance phases of treatment.
During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse treatment program.
Forms and administration
Suboxone is available as an oral film that can be used under your tongue (sublingual) or between your gums and your cheek (buccal).
Bunavail is available as a film that’s placed between your gums and your cheek (buccal).
Effectiveness
Suboxone and Bunavail contain the same drugs and are used in the same way to treat opioid dependence. They’re likely to be equally effective. The decision to use Suboxone or Bunavail is based on personal preferences for use of one product or the other.
Side effects and risks
Suboxone and Bunavail contain the same drugs and cause similar common and serious side effects.
More common side effects
Examples of the more common side effects of Suboxone and Bunavail include:
- headache
- opioid withdrawal symptoms, such as body aches, abdominal cramps, and rapid heart rate
- nausea
- vomiting
- constipation
- stomach pain or upset
- diarrhea
- anxiety
- insomnia (trouble sleeping)
- sweating
- depression
- chills
- weakness or fatigue
- dizziness
- cough
- fever
- runny nose
- sore throat
- back pain
Serious side effects
Examples of serious side effects shared by Suboxone and Bunavail include:
- severe allergic reaction
- abuse and dependence
- hormone problems (adrenal insufficiency)
- liver damage
- severe withdrawal symptoms
- breathing problems
- coma
Costs
Suboxone and Bunavail are brand-name drugs. There’s a generic version of Suboxone, but there’s no generic version of Bunavail. Generic versions often cost less than brand-name drugs.
Bunavail usually costs less than brand-name or generic Suboxone. The actual amount you pay will depend on your insurance.
Suboxone vs. Naltrexone
Suboxone is a brand-name medication that contains two drugs: buprenorphine and naloxone. Buprenorphine is classified as an opioid partial agonist-antagonist. Naloxone is classified as an opioid antagonist.
Naltrexone is a generic medication. Naltrexone is classified as an opioid antagonist, similar to the naloxone contained in Suboxone.
Uses
Suboxone is FDA-approved to treat opioid dependence. This includes both the induction phase and the maintenance phases of treatment.
During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse treatment program.
Naltrexone is also approved to treat opioid dependence. However, it’s only approved for preventing relapse in people who have completely stopped abusing opioids.
Forms and administration
Suboxone comes as an oral film that can be used under your tongue (sublingual) or between your gums and your cheek (buccal).
Naltrexone comes as an oral tablet.
Effectiveness
A 2016 clinical study found that Suboxone was more effective for reducing opioid use than naltrexone over 12 weeks.
Side effects and risks
Suboxone and naltrexone have some similar side effects, and some that differ. Below are examples of these side effects.
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Costs
Suboxone is a brand-name drug. It’s also available in a generic version. Generic versions often cost less than brand-name drugs.
Naltrexone oral tablet is a generic drug. It’s not available as a brand-name drug. (However, naltrexone also comes as extended-release injection. This form is only available as the brand-name drug Vivitrol [see above].)
Naltrexone usually costs less than brand-name or generic Suboxone. The actual amount you pay will depend on your insurance.
Suboxone and alcohol
You should not drink alcohol if you’re taking Suboxone.
Consuming alcohol with Suboxone can increase your risk of dangerous side effects, such as:
- trouble breathing
- low blood pressure
- excessive sleepiness
- coma
Suboxone interactions
Suboxone can interact with several other medications. It can also interact with certain supplements as well as certain foods.
Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.
Suboxone and other medications
Below is a list of medications that can interact with Suboxone. This list does not contain all drugs that may interact with Suboxone.
Before taking Suboxone, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Benzodiazepines
Taking Suboxone with benzodiazepines can increase the risk of severe side effects such as severe sedation (sleepiness), breathing problems, coma, and death.
Examples of benzodiazepines include:
- alprazolam (Xanax)
- clonazepam (Klonopin)
- diazepam (Valium)
- midazolam
Drugs that block metabolism of Suboxone
Certain medications that block an enzyme called cytochrome P450 3A4 (CYP3A4) can decrease how fast the body breaks down Suboxone. Taking these drugs with Suboxone can increase the risk of side effects.
Examples of these medications include:
- erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin)
- fluconazole (Diflucan)
- itraconazole (Sporanox)
- ketoconazole
- HIV protease inhibitors, such as atazanavir (Reyataz) and ritonavir (Norvir)
Drugs that increase metabolism of Suboxone
Certain medications make an enzyme called cytochrome P450 3A4 (CYP3A4) more active and can increase how fast the body breaks down Suboxone. This can make Suboxone less effective.
Examples of these medications include:
- carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
- phenobarbital
- phenytoin (Dilantin, Phenytek)
- primidone (Mysoline)
- rifampin (Rifadin)
Serotonergic drugs
Taking Suboxone with medications that increase serotonin levels in your body might increase your risk of developing serotonin syndrome, a drug reaction that can be dangerous.
Examples of medications that increase serotonin levels include:
- antidepressants, such as:
- selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil, Pexeva, Brisdelle), and sertraline (Zoloft)
- serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
- tricyclic antidepressants such as amitriptyline, desipramine (Norpramin), and imipramine (Tofranil)
- monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and selegiline (Emsam, Eldepryl, Zelapar)
- certain opioids such as fentanyl (Fentora, Abstral, others) and tramadol (Ultram, Conzip)
- buspirone, an anxiety medication
- monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), linezolid (Zyvox), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate)
Anticholinergic drugs
Anticholinergic drugs block the action of a chemical messenger called acetylcholine. Taking these drugs with Suboxone might increase the risk of side effects such as constipation and urinary retention. Examples of these drugs include:
- fesoterodine (Toviaz)
- oxybutynin (Gelnique, Ditropan XL, Oxytrol)
- scopolamine (Transderm Scop)
- tolterodine (Detrol)
Suboxone and Xanax
Xanax (alprazolam) is classified as a benzodiazepine. Taking Suboxone with benzodiazepines, including Xanax, can increase the risk of severe side effects. These include severe sedation (sleepiness), breathing problems, coma, and death.
Suboxone and tramadol
Taking tramadol (Ultram, Conzip) with Suboxone can increase the risk of side effects such as serotonin syndrome and decreased breathing. Suboxone may also make tramadol less effective for treating pain.
Suboxone and Adderall
There are no known interactions between Adderall (amphetamine and dexamphetamine salts) and Suboxone.
Suboxone and Klonopin
Klonopin (clonazepam) is classified as a benzodiazepine. Taking Suboxone with benzodiazepines, including Klonopin, can increase the risk of severe side effects. These include severe sedation (sleepiness), breathing problems, coma, and death.
Suboxone and gabapentin
There are no known interactions between gabapentin (Neurontin) and Suboxone.
Suboxone and anesthesia
Suboxone and anesthesia used for surgery may interact and increase your risk of serious side effects. Before having surgery, talk with your doctor about your treatment with Suboxone. You may need to temporarily stop taking Suboxone.
Suboxone and Ambien
Taking Suboxone with Ambien (zolpidem) can increase the risk of severe side effects. These include severe sedation (sleepiness), breathing problems, coma, and death.
Suboxone and codeine
Taking codeine with Suboxone can increase the risk of side effects such as decreased breathing. Suboxone may also make codeine less effective for treating pain.
Suboxone and herbs and supplements
Suboxone can interact with certain supplements or herbs you may be taking.
Herbs and supplements that affect serotonin
Supplements that affect serotonin levels can increase your risk of developing serotonin syndrome.
Examples of these supplements include:
- 5-HTP
- garcinia
- L-tryptophan
- St. John’s wort
Herbs and supplements that cause sedation
Some herbs and supplements can cause sleepiness. Taking these along with Suboxone might increase your risk of excessive sleepiness. Examples of these supplements include:
- chamomile
- kava
- melatonin
- valerian
St. John’s wort
St. John’s wort can make an enzyme called cytochrome P450 3A4 more active in your body. Because of this, taking St. John’s wort with Suboxone can cause your body to get rid of Suboxone more quickly. This can make Suboxone less effective.
Suboxone and grapefruit
Drinking grapefruit juice while taking Suboxone might increase levels of Suboxone and increase your risk of side effects. If you’re taking Suboxone, don’t drink grapefruit juice.
How to take Suboxone
You should take Suboxone according to your doctor’s instructions.
Timing
When you’ll take the drug depends on which treatment phase you’re in: induction or maintenance.
- Induction phase: During this phase, the drug decreases your withdrawal symptoms while you stop or reduce opioid use. You’ll receive Suboxone at your doctor’s office during the induction phase. During this time, your doctor will give you specific instructions on how and when to take the medication during the maintenance phase.
- Maintenance phase: During this phase, the drug keeps your withdrawal symptoms and cravings in check as you complete your drug abuse or addiction treatment program. You’ll take Suboxone once daily at about the same time each day during this phase. You can do this at home.
Taking Suboxone with food
Suboxone is not swallowed. Instead, the film is placed under your tongue or between your gums and your cheek, where it will dissolve.
Because it’s absorbed in your mouth and not your stomach, you can take it on an empty stomach or after a meal. However, you should not consume food or drink anything while the film is in your mouth.
Suboxone and pregnancy
Suboxone contains two drugs: buprenorphine and naloxone. Research is limited on how these two drugs might affect a human pregnancy.
Available studies have not found any major birth defects or other effects on the fetus when buprenorphine is used during pregnancy. For naloxone, there’s not enough information available about its use during pregnancy to know what its effects might be.
Despite the limited research, it’s clear that using Suboxone during pregnancy can cause a condition called neonatal opioid withdrawal syndrome in newborn infants. Symptoms can include:
- irritability
- diarrhea
- vomiting
- excessive crying
- trouble sleeping
- failure to gain weight
In addition, women who take Suboxone while pregnant may need additional pain medication during labor and delivery. This is because Suboxone blocks the effects of opioid medications, which may be used during labor and delivery to relieve pain.
The American Society of Addiction Medicine recommends treatment with methadone rather than Suboxone for pregnant women who are opioid dependent. They also recommend buprenorphine alone (not the Suboxone combination) as an alternative choice.
It’s important to note that treatment for opioid dependence is still important if you’re pregnant. Untreated opioid dependence in pregnant women carries serious risks. It’s been linked with low birthweight, preterm birth, and fetal death.
If you’re pregnant and dependent on opioids, talk to your doctor. They can help you determine the best treatment for you during your pregnancy.
Suboxone and breastfeeding
Suboxone contains two drugs: buprenorphine and naloxone. These drugs are both thought to be safe to use during breastfeeding.
Still, if you’re taking Suboxone and breastfeeding, you should watch your baby for side effects such as:
- excessive sleepiness
- failure to gain weight
- inactivity or lethargy
- trouble breathing
If any of these potential side effects happen in your baby, contact your doctor right away. If your baby is not breathing or you cannot wake them up, call 911 or emergency medical services.
Common questions about Suboxone
Here are answers to some frequently asked questions about Suboxone.
Is Suboxone a controlled substance?
Yes, Suboxone is a controlled substance. It’s classified as a schedule three (III) prescription drug. This means it has an accepted medical use, but may cause physical or psychological dependence and may be abused.
The government has created special rules for how schedule III drugs can be prescribed by a doctor and dispensed by a pharmacist. To find out more, talk to your doctor or pharmacist.
Is Suboxone methadone?
No, Suboxone is not methadone. Suboxone contains two drugs: buprenorphine and naloxone. While methadone is also used to treat opioid dependence, it’s a different drug than Suboxone.
How long does Suboxone take work?
Suboxone begins to work within 30 to 60 minutes.
Suboxone warnings
Suboxone may not be right for you if you have certain medical conditions. Examples of these conditions include:
- Lung disease. Suboxone can cause breathing problems. These problems are more likely to be severe in people with lung diseases, including chronic obstructive pulmonary disorder, asthma, and bronchitis.
- Liver disease. People with liver disease might have an increased risk of withdrawal symptoms when taking Suboxone. And people with moderate-to severe liver disease may not be able to take Suboxone.
- Head injury. Suboxone can increase the pressure in fluid in the spinal cord and brain. For people who have had a head or brain injury in the past, this effect can cause dangerous side effects, including loss of consciousness.
Suboxone expiration
When Suboxone is dispensed, an expiration date is added to the label on the bottle. This date is typically one year from the date the medication was dispensed.
The purpose of these expiration dates is to guarantee the effectiveness of the medication during this time.
The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. However, an FDA study showed that many medications may still be good beyond the expiration date listed on the bottle.
How long the medication remains good can depend on many factors, including how and where the medication is stored. Suboxone should be stored at room temperature, at about 77°F (25°C).
If you have unused medication that has gone past its expiration date, talk to your pharmacist about whether you might still be able to use it.
Professional information for Suboxone
The following information is provided for clinicians and other healthcare professionals.
Mechanism of action
Suboxone contains buprenorphine and naloxone. Buprenorphine is a partial agonist at the mu-opioid receptor and is an antagonist at the kappa-opioid receptor. Stimulation of the mu receptor causes analgesia, respiratory depression, euphoria, and dependence.
Due to its partial agonist effects, buprenorphine may reduce the pleasurable effects when mu-opioid receptor agonists are used.
Naloxone is a mu-opioid receptor antagonist. Naloxone is included in this formulation to prevent its use parenterally. Naloxone has poor oral bioavailability and minimal amounts are absorbed when administered sublingually or buccally.
Pharmacokinetics and metabolism
Suboxone contains buprenorphine and naloxone. Buprenorphine has better absorption when given sublingually compared to orally. The half-life is about 24 to 42 hours.
Naloxone has poor bioavailability when administered sublingually. The half-life is about 2 to 12 hours.
Contraindications
Suboxone is contraindicated in people with a known hypersensitivity to buprenorphine or naloxone.
Abuse and dependence
Suboxone is a schedule III medication that’s abused similar to other opioid medications. Long-term use of Suboxone can lead to physical and psychological dependence and drug-craving and drug-seeking behavior.
In order to prevent abuse and diversion, multiple refills should not be prescribed or dispensed at the beginning of treatment.
Storage
Suboxone should be stored at room temperature, at about 77°F (25°C).
Disclaimer: MedicalNewsToday has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.