What Happens if You Stop Using Suboxone and Start Using Opiates Again

Brand names:

• Suboxone®
  • Sublingual tablet (under the tongue): two mg buprenorphine with 0.5 mg naloxone, 8mg buprenorphine with two mg naloxone
  • Sublingual film (under the tongue or inside the cheek): 2 mg buprenorphine with 0.v mg naloxone, 4 mg buprenorphine with one mg naloxone, 8 mg buprenorphine with two mg naloxone, 12 mg buprenorphine with iii mg naloxone
• Bunavail®
  • Buccal film (inside the cheek): 2.1 mg buprenorphine with 0.iii mg naloxone, 4.2 mg buprenorphine with 0.seven mg naloxone, 6.3 mg buprenorphine with one mg naloxone
• Zubsolv®
  • Sublingual tablet (under the natural language): 0.7 mg buprenorphine with 0.18 mg naloxone, i.4 mg buprenorphine with 0.36 mg naloxone, ii.9 mg buprenorphine with 0.71 mg naloxone, 5.vii mg buprenorphine with 1.4 mg naloxone, 8.6 mg buprenorphine with ii.ane mg naloxone, eleven.4 mg buprenorphine with ii.ix mg naloxone
• Cassipa®
  • Sublingual film (under the tongue): xvi mg buprenorphine with 4 mg naloxone

Generic name: buprenorphine/naloxone (byoo pre NOR feen/ nah LOX own)

All FDA black box warnings are at the cease of this fact canvas. Delight review before taking this medication.

Medication Assisted Treatment (MAT)

Medication assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies for the treatment of substance apply disorders. A combination of medication and behavioral therapies is effective in the handling of substance use disorders and tin can help some people to sustain recovery.

What is buprenorphine/naloxone and what does information technology treat?

Buprenorphine/naloxone is a medication that works in the brain to care for opioid employ disorder. Opioids include heroin and prescription pain relievers such as hydrocodone, oxycodone, morphine, and fentanyl.

Buprenorphine is the active drug in buprenorphine/naloxone. Buprenorphine is known as a partial opioid agonist which means information technology partially works like an opioid and the effect is weaker than full agonists like heroin and methadone. It also has a "ceiling issue" so the opioid furnishings level off even with further dose increases which reduces the risk of misuse, dependency, and side effects. Buprenorphine lowers the effects of opioid withdrawal symptoms and cravings to apply opioids without having total opioid potency or effects. This helps people who take the medication abjure from other opioids.

The naloxone part of buprenorphine/naloxone is known as an opioid antagonist or "blocker". Information technology is simply absorbed and activated in the body if the tablet or film is injected instead of being dissolved in the mouth as prescribed. If naloxone is injected into the bloodstream, it will cause someone who is dependent on opioids to accept uncomfortable withdrawal symptoms. This helps discourage people who are dependent on intravenous (4) opioids from injecting buprenorphine/naloxone.

It is important to combine buprenorphine/naloxone handling with counseling and other support.

Symptoms of opioid use disorder include:

• Being unable to quit using opioids despite problems with wellness and relationships
• Needing more opioids to reach the same effect
• Going through withdrawal symptoms (sweating, shaking, nausea, vomiting, diarrhea, body aches, feet, irritability, runny nose) when unable to use opioids
• Spending the majority of time using or finding a way to use opioids
• Having a desire simply an inability to subtract the amount of opioids used
• ​Giving upward enjoyable activities in order to use opioids

What is the most important information I should know about buprenorphine/naloxone?

Your healthcare provider will decide when buprenorphine/naloxone should be started. If it is started also early on after using other opioids, you could experience withdrawal symptoms, such as sweating, shaking, nausea, vomiting, diarrhea, body aches, anxiety, irritability, or runny olfactory organ.

Practise not stop taking buprenorphine/naloxone, even when you experience meliorate. With input from you, your health care provider will appraise how long you will need to have the medicine. If buprenorphine/naloxone is stopped abruptly, y'all may have withdrawal symptoms.

Missing doses of buprenorphine/naloxone may increase your hazard for relapse.

Respiratory low (slowed breathing) and death can rarely happen when buprenorphine/naloxone is taken equally prescribed. This hazard is increased when buprenorphine/naloxone is injected into the torso or when it is mixed with other depressants including benzodiazepine medications (such equally lorazepam, diazepam, or alprazolam) and alcohol. Patients taking buprenorphine/naloxone or their caregivers should seek immediate medical attending if they start to experience unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficulty breathing, or unresponsiveness.

Do not inject ("shoot-upwardly") buprenorphine/naloxone. This can cause uncomfortable withdrawal symptoms, respiratory depression (slowed breathing), or death in someone dependent on opioids.

Buprenorphine/naloxone should not be used as a pain reliever. There take been deaths reported in people who accept never used opioids before after using low doses of buprenorphine/naloxone.

Buprenorphine/naloxone is non recommended in people with severe liver affliction. Liver injury is rare. This can be monitored through claret tests. Warning your doctor immediately if you experience any yellowing of your skin and/or eyes, severe tum hurting, or astringent nausea or airsickness.

Tell all of your providers and pharmacists that yous are on buprenorphine/naloxone. You lot should not take other medications with buprenorphine/naloxone without talking to your provider.

Do not drive or operate heavy machinery until y'all know how yous will respond to buprenorphine/naloxone.

Shop buprenorphine/naloxone out of the reach and sight of children. Buprenorphine/naloxone can crusade serious respiratory depression (slowed breathing) and death in children.

Are there specific concerns well-nigh buprenorphine/naloxone and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with substance apply disorders that wish to become pregnant face important decisions and challenges. Agile substance use disorders during pregnancy put the fetus at great chance. Information technology is of import to discuss the risks and benefits of continued treatment with your doctor and caregivers.

Opioid use disorder in pregnancy is associated with adverse outcomes such as depression birth weight, preterm birth, and fetal death. Receiving treatment for opioid use disorder during pregnancy lowers these risks.

The effects of buprenorphine/naloxone on the fetus when used in pregnant women are unknown. Buprenorphine/naloxone did not announced to cause structural abnormalities during animal studies. At that place was testify of obstructed labor, fetal death, neonatal death, and developmental delays in animal studies. These results cannot be practical to humans. Buprenorphine without naloxone did not prove an increased take chances of major structural abnormalities when studied in pregnant women. Opioid withdrawal symptoms may occur in newborn infants of women who were taking buprenorphine (without naloxone) during pregnancy. There accept been reports of poor feeding, diarrhea, irritability, tremor, trouble breathing, low heart rate, rigidity, and seizure in infants exposed to buprenorphine.

Methadone is improve studied for significant women needing medication for opioid use disorder. Buprenorphine without naloxone is a reasonable alternative to methadone for pregnant women. Buprenorphine/naloxone should only be used in pregnancy if the benefits outweigh the risk to the fetus.

Regarding breastfeeding, circumspection is brash since buprenorphine does pass into chest milk. Pocket-sized studies of buprenorphine utilize in breastfeeding women did not show adverse events in breastfed infants. There is no information on buprenorphine/naloxone in breastfeeding. Nursing mothers who are taking buprenorphine/naloxone should monitor their infants for signs of increased drowsiness or trouble animate.

What should I hash out with my health care provider earlier taking buprenorphine/naloxone?

• Symptoms of your condition that bother you the most
• If y'all have allergies to any medications
• If you accept thoughts of suicide or harming yourself
• Medications you have taken in the past for your condition, whether they were effective or caused any agin effects
• If you experience side effects from your medications. Some side effects may pass with time, but others may require changes in the medication.
• Any other psychiatric or medical problems you lot have, including a history of liver disease
• All other medications y'all are currently taking (including over the counter products, herbal and nutritional supplements) and whatever medication allergies you lot have
• Other non-medication treatments you are receiving, such as talk therapy or counseling. Your provider tin can explain how these different treatments work with the medication.
• If y'all are meaning, plan to become pregnant, or are breastfeeding
• If you utilize illegal drugs or narcotics

How should I take buprenorphine/naloxone?

Buprenorphine/naloxone is bachelor as a tablet or film that dissolves in the mouth. On the first day of buprenorphine/naloxone treatment, a starting dose up to 8mg/2mg is ordinarily recommended. This starting dose should exist advisedly adapted nether the supervision of a certified health care provider to find the most rubber and constructive dose for y'all. The recommended daily maintenance dose of buprenorphine/naloxone tablets or films is commonly 16mg/4mg taken once per day. Only your healthcare provider can determine the correct dosage form or dose.

Buprenorphine/naloxone tablets should be dissolved under the tongue. Practice not swallow. Go on the tablets in place under the tongue until completely dissolved. Practise not eat or drink anything until the tablets are completed dissolved. If more than than one tablet is needed to reach the prescribed dose, identify all tablets in different places under the tongue at the same time. If this is not possible, run into the detailed instructions on the medication guide that came with your prescription or inquire your wellness care provider.

When you lot first brainstorm using buprenorphine/naloxone motion picture, information technology should be dissolved under the natural language. Place one film under the natural language until it is completely dissolved. Do not move the film later placement. You can place the film under the natural language on either the left or correct side shut to the base of the natural language. If a second film is needed, the 2nd should exist placed on the opposite side. If a third film is required, place it on either side subsequently the commencement two films take dissolved. Later on a few days, you can make up one's mind to dissolve buprenorphine/naloxone films nether the tongue or on the inside of the cheek.

Patients taking Bunavail volition apply the film using a dry finger directly to the inside of their cheek. Place the moving-picture show with the text (BN2, BN4, BN6) confronting the inside cheek and press for 5 seconds. Keep picture in place until information technology dissolves. If using more than 1 picture show, so place the second film on the opposite cheek. No more than two films should be placed on the inside of ane cheek at the same time.

Patients should exist stabilized on another buprenorphine-containing product at a dose of 16 mg before starting Cassipa®. Do not cut, chew, or eat Cassipa®.

Potable h2o to moisten your mouth before taking the movie to help it dissolve meliorate. Buprenorphine/naloxone films will not work every bit well if swallowed. Buprenorphine/naloxone film should be taken whole. Practice non cut, chew, or swallow the film.

Your provider or pharmacist can show y'all how to take buprenorphine/naloxone. Yous can find detailed instructions on how to use buprenorphine/naloxone tablets or films in the medication guide that comes with your prescription from the pharmacy.

Exercise not switch from one dosage course of buprenorphine/naloxone to another medicine that contains buprenorphine without talking with your doctor. The corporeality of buprenorphine may be different than other buprenorphine containing medicines and your dr. will prescribe a starting dose that is right for you.

Consider using a calendar, pillbox, alarm clock, or cell phone alert to assistance yous remember to take your medication. You may also inquire a family member or a friend to remind you or check in with you to be sure you lot are taking your medication.

What happens if I miss a dose of buprenorphine/naloxone?

If y'all miss a dose of oral buprenorphine/naloxone, accept it equally soon as you remember unless information technology is closer to the fourth dimension of your next dose. Do non double your adjacent dose or accept more than what is prescribed.

What should I avoid while taking buprenorphine/naloxone?

Avoid drinking alcohol, using sedatives, or other opioid pain medications (such as codeine, hydrocodone, oxycodone, or morphine), or using illegal drugs while you are taking buprenorphine/naloxone. They may increase agin furnishings (due east.g., sedation, overdose, death) of the medication.

Continue in mind that some cough syrups may contain opioid pain medication. Discuss all medications with your physician and pharmacist prior to taking buprenorphine/naloxone.

What happens if I overdose with buprenorphine/naloxone?

If an overdose occurs, call your doctor or 911. Yous may demand urgent medical care. You may also contact the poisonous substance control eye at ane-800-222-1222.

Evzio® (naloxone) injection or Narcan® (naloxone) nasal spray is a medication that can be used to reverse overdose from opioids including buprenorphine/naloxone. Y'all should always phone call 911 after giving someone naloxone to care for an overdose. Enquire your provider if naloxone is correct for yous.

What are the possible side furnishings of buprenorphine/naloxone?

Common side furnishings

• Headache, nausea, vomiting, increased sweating, constipation, problem sleeping (insomnia), pain, and swelling in the artillery and legs (peripheral edema)
• Signs and symptoms of withdrawal from opioids (such as shaking, stomach cramps, diarrhea, restlessness, irritability, anxiety, body aches, or runny nose)
• Numbness of the mouth, redness of the oral cavity, and burning or painful tongue may occur with the buprenorphine/naloxone pic

Rare/serious side furnishings

• Orthostatic hypotension (low claret pressure when standing)
• Changes in liver function or liver failure
• Changes in adrenal gland function
• Slumber-related animate disorders
• Allergic reactions
  • Avoid with known hypersensitivity (rashes, hives, itching) to buprenorphine, naloxone or any of the ingredients with them
• ​Overdose and expiry
  • Signs of overdose include pinpoint pupils, sedation, low blood pressure, and respiratory depression (slowed animate)
  • This risk is higher when buprenorphine/naloxone is used IV or at the same fourth dimension as sedatives (like benzodiazepines) or other depressants (like alcohol)

Are there any risks for taking buprenorphine/naloxone for long periods of time?

Buprenorphine is a partial opioid agonist. Like other opioids, buprenorphine causes physical dependency when taken daily for a long period of fourth dimension. This means that you may have withdrawal symptoms if buprenorphine/naloxone is stopped abruptly. Withdrawal symptoms when stopping buprenorphine/naloxone are usually not every bit astringent as with other total opioids. Talk to your provider before stopping buprenorphine/naloxone.

What other medications may interact with buprenorphine/naloxone?

There have been reports of respiratory depression (slowed breathing) and expiry in patients taking buprenorphine/naloxone with benzodiazepine medications such as alprazolam (Xanax®), clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®), and temazepam (Restoril®). These medications should be taken exactly as prescribed. Information technology is very dangerous to take buprenorphine/naloxone with benzodiazepines if you do not have a prescription.

The post-obit medications may increase the furnishings of buprenorphine/naloxone:

• Sure antibiotics such equally clarithromycin (Biaxin®) and erythromycin (Ery-Tab®)
• Sure antidepressants such as fluoxetine (Prozac®), phenelzine (Nardil®)
• Antifungals, such equally fluconazole (Diflucan®), ketoconazole (Nizoral®), and itraconazole (Sporanox®)
• ​Certain HIV medications known as protease inhibitors: indinavir (Crixivan®), ritonavir (Norvir®), saquinavir (Fortovase®, Invirase®), and lopinavir/ritonavir (Kaletra®)

The following medications may subtract the effects of buprenorphine/naloxone:

• Certain seizure medications such equally phenobarbital, carbamazepine (Tegretol®), and phenytoin (Dilantin®)
• The antibiotic rifampicin (Rifadin®)
• The opioid "blocker" naltrexone (Revia®, Vivitrol®)

​How long does it take for buprenorphine/naloxone to work?

Buprenorphine/naloxone will brainstorm working shortly afterward taking one dose.

Summary of FDA Black Box Warnings

This medication has an opiate drug in it. The FDA has found that the use of opiate drugs with benzodiazepine drugs or other sedating medications tin result in serious adverse reactions including slowed or hard breathing and death. Benzodiazepine drugs include drugs like alprazolam, clonazepam, and lorazepam. Benzodiazepine drugs are used to treat wellness problems like feet, trouble sleeping, or seizures. Patients taking opioids with benzodiazepines, other sedating medications, or alcohol, and caregivers of these patients, should seek firsthand medical attending if they start to experience unusual dizziness or lightheadedness, farthermost sleepiness, slowed or difficulty animate, or unresponsiveness.

Provided by

(Jan 2021)

©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP). CPNP makes this document available nether the Artistic Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided equally a customs outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and advisory purposes merely and is non medical communication. This information contains a summary of important points and is non an exhaustive review of information about the medication. E'er seek the advice of a physician or other qualified medical professional with any questions y'all may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional person advice as a outcome of any data provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability declared as a event of the data provided herein.

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Source: https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone)

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