Treatment: Buprenorphine / Naloxone

Buprenorphine/naloxone is a combination medicine used to treat opioid dependence. It works in the brain and nervous system to help prevent withdrawal symptoms in someone who has stopped taking opiates.

Buprenorphine is an agonist that can prevent symptoms and suppress cravings. Naloxone is present in this combination medicine to discourage misuse.

Taking

Buprenorphine/naloxone tablets come as 2 mg/0.5 mg and 8 mg/2 mg and are taken under the tongue. Common daily doses of buprenorphine/naloxone are between 12/3 mg and 16/4 mg, although some people need higher or lower doses. You should normally reach your ideal dose of buprenorphine in a few days.

Place the medication under your tongue for 5 to 10 minutes and let it dissolve completely. Do not swallow, crush, cut, or chew the tablet. Do not eat, drink, smoke, or talk while the tablet is dissolving.

Do not suddenly stop taking buprenorphine/naloxone without checking with your doctor. You may experience withdrawal symptoms, such as pain, cramps, vomiting, diarrhea, anxiety, sleeping problems, and cravings. If you need to stop buprenorphine/naloxone, your doctor may need to gradually lower your dose.

 The facts

  • Buprenorphine/naloxone’s effects are identical to buprenorphine alone. When taken as prescribed: very little naloxone is absorbed under the tongue and not enough to feel any effects.
  • If crushed and injected or snorted – buprenorphine/naloxone is dangerous, and will likely cause severe withdrawal symptoms due to the naloxone in this medication, especially if you have been using opioids such as heroin, morphine or methadone.
  • Because of the presence of naloxone, some doctors are more confident in prescribing it on a take-home basis, so you may be able to get more freedom earlier in treatment.
  • You could come across less pressure from others to sell your medication, as its street value is lower than many other opioids.
  • Buprenorphine/naloxone can interact with other medications, causing unwanted side effects, so you may want to talk to your doctor if you have multiple prescriptions (eg some anti-retroviral medications used to treat HIV) though your doctor should quickly spot interaction effects and change your dose accordingly.
  • Buprenorphine/naloxone can be given as a single daily dose.
  • Dosage can be progressively adjusted until the correct dosage is found that holds the patients treatment and suppresses opioid withdrawal symptoms.

Possible side effects of buprenorphine/naloxone:

Not everyone gets side effects; some of buprenorphine/naloxone’s more common side effects are:

  • constipation
  • dizziness
  • drowsiness
  • sweating
  • nausea
  • vomiting
  • weakness
  • headaches

Side effects often wear off over time; any new medication can take time to adjust to.

Returning to treatment?

If you’ve been on buprenorphine/naloxone or buprenorphine before and experienced difficulty, you should discuss this with the doctor. It may be that you were on too low a dose last time, or this may not be the medication for you.