Suboxone (generic: buprenorphine/naloxone) is a prescription medication used to treat adults who are addicted to opioid (narcotic) drugs. Suboxone is a single tablet (or film) containing 2 drugs, buprenorphine and naloxone. Buprenorphine belongs to a group of drugs called opioid (narcotic) partial agonists, and naloxone belongs to a group of drugs called opioid antagonists that reverse the effects of opioid medications. Together these drugs prevent withdrawal symptoms when people stop taking opioid (narcotic) drugs.
This medication comes in the form of sublingual film or tablets to be dissolved under the tongue, once daily.
Common side effects of Suboxone include nausea, vomiting, headaches, and sweating.
Suboxone is a prescription medicine used to treat adults who are addicted to (dependent on) opioid drugs (either prescription or illegal) as part of a complete treatment program that also includes counseling and behavioral therapy.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Suboxone can cause serious side effects, including:
- See "Drug Precautions".
- Respiratory problems. You have a higher risk of death and coma if you take Suboxone with other medicines, such as benzodiazepines.
- Sleepiness, dizziness, and problems with coordination
- Dependency or abuse
- Liver problems. Call your doctor right away if you notice any of these signs of liver problems: Your skin or the white part of your eyes turning yellow (jaundice), urine turning dark, stools turning light in color, you have less of an appetite, or you have stomach (abdominal) pain or nausea. Your doctor should do tests before you start taking and while you take Suboxone.
- Allergic reaction. You may have a rash, hives, swelling of the face, wheezing, or a loss of blood pressure and consciousness. Call a doctor or get emergency help right away.
- Opioid withdrawal. This can include: shaking, sweating more than normal, feeling hot or cold more than normal, runny nose, watery eyes, goose bumps, diarrhea, vomiting, and muscle aches. Tell your doctor if you develop any of these symptoms.
- Decrease in blood pressure. You may feel dizzy if you get up too fast from sitting or lying down.
Common side effects of Suboxone sublingual film include:
- Drug withdrawal syndrome
- Numb mouth
- Painful tongue
- The inside of your mouth is more red than normal
- Intoxication (feeling lightheaded or drunk)
- Disturbance in attention
- Irregular heart beat (palpitations)
- Decrease in sleep (insomnia)
- Blurred vision
- Back pain
Tell your doctor about any side effect that bothers you or that does not go away.
These are not all the possible side effects of Suboxone sublingual film. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects.
Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Suboxone may affect the way other medicines work, and other medicines may affect how Suboxone works. Some medicines may cause serious or life-threatening medical problems when taken with Suboxone.
Sometimes the doses of certain medicines and Suboxone may need to be changed if used together. Do not take any medicine while using Suboxone until you have talked with your doctor. Your doctor will tell you if it is safe to take other medicines while you are using Suboxone.
Be especially careful about taking other medicines that may make you sleepy, such as pain medicines, tranquilizers, antidepressant medicines, sleeping pills, anxiety medicines or antihistamines. Also tell your doctor if you are taking:
- antifungal medicines (such as ketoconazole, fluconazole, or itraconazole)
- certain antibiotics (such as erythromycin)
- HIV protease inhibitors (such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir))
- efavirenz (Sustiva)
- carbamazepine (Tegretol)
- phenytoin (Dilantin)
- rifampicin (Rifadin)
Know the medicines you take. Keep a list of them to show your doctor or pharmacist each time you get a new medicine.
Suboxone can cause serious and life-threatening breathing problems. Call your doctor right away or get emergency help if:
These can be signs of an overdose or other serious problems.
- You feel faint, dizzy, or confused
- Your breathing gets much slower than is normal for you
- Suboxone contains an opioid that can cause physical dependence.
Do not stop taking Suboxone without talking to your doctor. You could become sick with uncomfortable withdrawal signs and symptoms because your body has become used to this medicine.
- Physical dependence is not the same as drug addiction.
- Suboxone is not for occasional or “as needed” use.
- An overdose and even death can happen if you take benzodiazepines, sedatives, tranquilizers, antidepressants, or alcohol while using Suboxone. Ask your doctor what you should do if you are taking one of these.
Call a doctor or get emergency help right away if you:
- Feel sleepy and uncoordinated
- Have blurred vision
- Have slurred speech
- Cannot think well or clearly
- Have slowed reflexes and breathing
Do not inject (“shoot-up”) Suboxone.
- Injecting this medicine may cause life-threatening infections and other serious health problems.
- Injecting Suboxone may cause serious withdrawal symptoms such as pain, cramps, vomiting, diarrhea, anxiety, sleep problems, and cravings.
- In an emergency, have family members tell emergency department staff that you are physically dependent on an opioid and are being treated with Suboxone.
Do not take Suboxone if you are allergic to buprenorphine or naloxone.
Do not drive, operate heavy machinery, or perform any other dangerous activities until you know how this medication affects you. Buprenorphine can cause drowsiness and slow reaction times. This may happen more often in the first few weeks of treatment when your dose is being changed, but can also happen if you drink alcohol or take other sedative drugs when you take Suboxone.
You should not drink alcohol while using Suboxone, as this can lead to loss of consciousness or even death.
Grapefruit and grapefruit juice may interact with Suboxone and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.
Before taking Suboxone, tell your doctor if you:
- Have trouble breathing or lung problems
- Have an enlarged prostate gland (men)
- Have a head injury or brain problem
- Have problems urinating
- Have a curve in your spine that affects your breathing
- Have liver or kidney problems
- Have gallbladder problems
- Have adrenal gland problems
- Have Addison's disease
- Have low thyroid (hypothyroidism)
- Have a history of alcoholism
- Have mental problems such as hallucinations (seeing or hearing things that are not there)
- Have any other medical condition
- Are pregnant or plan to become pregnant.
- Are breastfeeding or plan to breastfeed.
Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.
Tell your doctor if you are pregnant or plan to become pregnant. It is not known if Suboxone will harm your unborn baby. If you take Suboxone while pregnant, your baby may have symptoms of withdrawal at birth. Talk to your doctor if you are pregnant or plan to become pregnant.
Tell your doctor if you are breastfeeding or plan to breastfeed. Suboxone can pass into your milk and may harm the baby. Talk to your doctor about the best way to feed your baby if you take Suboxone. Breastfeeding is not recommended while taking Suboxone.
- Always take Suboxone exactly as your doctor tells you. Your doctor may change your dose after seeing how it affects you. Do not change your dose unless your doctor tells you to change it.
- Do not take Suboxone more often than prescribed by your doctor.
Suboxone Sublingual Film:
- Each Suboxone sublingual film comes in a sealed child-resistant foil pouch. Wait to open Suboxone until right before you use it.
- To open your Suboxone sublingual film foil pouch, fold along the dotted line and tear down at slit or cut with scissors along the arrow.
- Before taking Suboxone, drink water to moisten your mouth. This helps the film dissolve more easily.Hold the film between two fingers by the outside edges.
- Place Suboxone sublingual film under your tongue, close to the base either to the left or right of the center
- If your doctor tells you to take 2 films at a time, place the second film under your tongue on the opposite side. Try to avoid having the films touch as much as possible.
- Keep the films in place until they have completely dissolved.
- If you are directed to take a third film, place it under your tongue on either side after the first 2 films have dissolved.
- While Suboxone is dissolving, do not chew or swallow the film because the medicine will not work as well.
- Talking while the film is dissolving can affect how well the medicine in Suboxone is absorbed.
Suboxone Sublingual Tablets:
- Put the tablets under your tongue. Let them dissolve completely.
- While Suboxone is dissolving, do not chew or swallow the tablet because the medicine will not work as well.
- Talking while the tablet is dissolving can affect how well the medicine in Suboxone is absorbed.
If you miss a dose of Suboxone, take your medicine when you remember. If it is almost time for your next dose, skip the missed dose and take the next dose at your regular time. Do not take 2 doses at the same time unless your doctor tells you to. If you are not sure about your dosing, call your doctor.
Do not stop taking Suboxone suddenly. You could become sick and have withdrawal symptoms because your body has become used to the medicine. Physical dependence is not the same as drug addiction. Your doctor can tell you more about the differences between physical dependence and drug addiction. To have fewer withdrawal symptoms, ask your doctor how to stop using Suboxone the right way.
If you take too much Suboxone or overdose, call Poison Control or get emergency medical help right away.
Take Suboxone exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.
Suboxone (sublingual film or tablet) is administered sublingually (dissolved under the tongue) as a single daily dose. Suboxone should be used in patients who have been initially inducted using Subutex (buprenorphine) sublingual tablets.
- Suboxone is indicated for maintenance treatment. The recommended target dosage of Suboxone is 16/4 mg buprenorphine/naloxone/day, as a single daily dose.
- The dosage of Suboxone should be progressively adjusted in increments/decrements of 2/0.5 mg or 4/1 mg buprenorphine/naloxone to a level that holds the patient in treatment and suppresses opioid withdrawal signs and symptoms.
- The maintenance dose of Suboxone is generally in the range of 4/1 mg buprenorphine/naloxone to 24/6 mg buprenorphine/naloxone per day depending on the individual patient. Dosages higher than this have not been demonstrated to provide any clinical advantage.
If you take too much Suboxone, call your local Poison Control Center or seek emergency medical attention right away.
Suboxone sublingual film is available in two dosage strengths:
- buprenorphine/naloxone 2 mg/0.5 mg, and
- buprenorphine/naloxone 8 mg/2 mg.
Active Ingredients: buprenorphine and naloxone.
Inactive Ingredients (film): polyethylene oxide, hydroxypropyl methylcellulose, maltitol, acesulfame potassium, lime flavor, citric acid, sodium citrate, FD&C yellow #6, and white ink.
Suboxone sublingual tablets are available in two dosage strengths:
- buprenorphine and naloxone 2 mg/0.5 mg and
- buprenorphine and naloxone 8 mg/2 mg
Active Ingredients: buprenorphine and naloxone
Inactive Ingredients (tablet): lactose, mannitol, cornstarch, povidone K30, citric acid, sodium citrate, FD&C yellow No. 6 color, magnesium stearate, acesulfame K sweetener and a lemon-lime flavor
Store at 25°C (77°F), excursions permitted to 15-30°C (59-86°F).
- Keep Suboxone in a safe place, out of the sight and reach of children.
Dispose of unopened Suboxone sublingual films as soon as you no longer need them:
- Remove the Suboxone film from its foil pouch.
- Drop the Suboxone film into the toilet.
- Repeat steps 1 and 2 for each Suboxone film. Flush the toilet after all unneeded films have been put into the toilet. Do not flush foil pouches or cartons down the toilet.
Disposal of unused Suboxone Sublingual Tablets:
- Dispose of unused Suboxone Sublingual Tablets as soon as you no longer need them.
- Flush unused tablets down the toilet.
Suboxone is a controlled substance (CIII) because it contains buprenorphine, which can be a target for people who abuse prescription medicines or street drugs. Keep your Suboxone in a safe place to protect it from theft. Never give your Suboxone to anyone else; it can cause death or otherwise harm them. Selling or giving away this medicine is against the law.
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