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    Suboxone

    What Is Suboxone? Dosage, Efficacy, and More

    Opioid addiction is an unfortunate epidemic, taking the lives of approximately 130 people each day, with an average of 1.5 million people suffering from an addiction to opioids. Many people end up developing an addiction to opioids after a doctor prescribes them for chronic pain.

    Suboxone treatments are by prescription only and are used to treat opioid addiction. While Suboxone is an effective solution to treat opioid dependence, it may not be suitable for others.  

    It’s always best to be honest with your doctor to determine if this is the right treatment plan for you.

    What Is Suboxone?

    Suboxone film contains two active ingredients, buprenorphine and naloxone. Patients will put it under their tongue or inside their cheek and it will dissolve in four to eight minutes.

    It is not recommended for patients to chew or swallow the film because it might not be as effective.

    The main purpose of Suboxone is to help individuals with an addiction to opioids, which includes morphine, heroin, oxycodone, and codeine, take control of their lives.  

    Suboxone falls into a group of treatment options called Medication-Assisted Treatment, or MAT. These treatments work by combining medications with behavioral therapies and counseling.

    The point of this type of treatment is to help patients manage their addiction and learn how to make changes in their lives to stay clean while offering continued support during recovery.

    Medication-Assisted Treatment options are personalized to fit the needs of the patient and can include family therapy for young adults and teenagers.

    What Does Suboxone Treat and Who Is It For?

    This medication is used in treating individuals who have an addiction to opioids, including illegal substances and prescription medication. Suboxone is effective in blocking the opioid receptors, which is what inhibits the cravings for opioids.

    It is also useful in preventing withdrawal symptoms, cutting down the chance of relapse and lowering death rates. Suboxone contains ingredients that come together to work in a similar way that heroin and prescription pills work in the body, the difference though is that this method has milder effects than most opioids.

    An ingredient used in this medication, naloxone, helps prevent patients from injecting or snorting and misusing it, making it a safer option to treat addiction.

    What Are the Ingredients of Suboxone?

    Each Suboxone film contains the active ingredients buprenorphine and naloxone. The films do come in various dosages, allowing doctors to customize treatment plans to fit the needs of the patient.

    The inactive ingredients of Suboxone include citric acid, lime flavor, sodium citrate, polyethylene oxide, acesulfame potassium, hydroxypropyl methylcellulose, maltitol, white ink, FD&C yellow #6. Please advise your healthcare provider if you have any allergy to any of these.

    Patient Types

    Suboxone should only be taken by adults and children over the age of 16. It should not be taken by patients with serious breathing problems or are allergic to buprenorphine or naloxone.

    Patients that take the Suboxone narcotic are those that want to manage their addiction and stop misusing medications and taking illegal drugs.

    Not enough research has been done to determine if Suboxone is a safe treatment plan for individuals over the age of 65. The ingredients could cause problems in the geriatric age group and should only be used with caution and under the close care of a physician.

    Geriatric patients may be on medications that can interact with Suboxone and a doctor will be able to determine if this is a suitable solution based on the patient’s history.

    Children under the age of 16 should not take this medication unless instruction by a doctor. If a child accidentally takes Suboxone, this can result in a medical emergency and can be fatal. Call a poison control center or 9-1-1 immediately.

    Common Side Effects of Suboxone

    Suboxone treatments, like any other medications, can cause mild to serious side effects. The most common side effects patients experience when taking it include:

    • Headache
    • Difficulty sleeping
    • Constipation
    • Sweating
    • Anxiety
    • Body aches
    • Rapid heart rate
    • Depression
    • Fatigue
    • Burning tongue

    It’s common for the side effects to go away after a few days of Suboxone treatments, but it can take a couple of weeks or months. If you have lingering symptoms that are more severe or don’t go away, you should talk to your doctor. Some of the more serious side effects are as follows

    • Abuse and dependence
    • Coma
    • Severe allergic reaction
    • Breathing problems
    • Severe withdrawal symptoms
    • Liver damage

    Before taking this medication, you should consult with your doctor if you have any questions about the possible side effects. Some side effects can be decreased with an adjustment to the dose of Suboxone you take.

    This, however, should only be done by a doctor and patients should never adjust their own doses.

    Warnings: Before Taking Suboxone, Talk to Your Healthcare Provider If…

    Before taking Suboxone, your doctor should know if you have any of the following:

    • Liver or kidney disease
    • Enlarged prostate or difficulties urinating
    • Breathing problems and/or lung disease
    • Head injury, brain tumor, or seizures
    • Abnormal curvature of the spine that affects your breathing
    • Mental illness and/or alcoholism

    You should also let your doctor know ahead of time if you’re pregnant or breastfeeding. The active ingredients found in Suboxone can be passed through breast milk and may cause breathing problems and drowsiness in the baby.

    You should also bring a list of current medications (prescription and over-the-counter) you take so your doctor can make sure none of them will interact with Suboxone.

    How Should You Take Suboxone?

    Patients should take this medication exactly as prescribed by their doctor. Suboxone doses will vary from patient to patient.

    It could take some time for the doctor to find the correct dose that works best for each individual. You should never take more Suboxone doses than prescribed, miss doses, or take the medication longer than prescribed.

    If you do miss a dose of Suboxone, you can take your dose when you remember unless it’s close to the time you have to take your next one. If it is close to your next dose, you can skip the dose you missed and continue your regular schedule with the next dose.

    If you have trouble remembering to take your doses, you can try to link it to an unrelated event like eating your breakfast or drinking your morning coffee.

    A Suboxone film goes on the inside of a patient’s cheek or under their tongue. It is not recommended to place more than two films on the inside cheek at a time.

    While the film dissolves, patients are advised to refrain from eating, drinking or even talking, as these can decrease the efficiency of it.

    The recommended dosage of Suboxone determined by the FDA is 16/4 milligrams, which is 16 milligrams of buprenorphine and 4 milligrams of naloxone. The typical maintenance Suboxone doses can range from 4/1 milligrams of buprenorphine/naloxone up to 24/6.

    There is no maximum recommended time for patients to be on the Suboxone treatment plan. Some patients may be successful in tapering down and no longer relying on opioids.

    There are some people though that may need to be on Suboxone indefinitely. The duration of the plan does vary from patient to patient and the doctor will help a patient decide what’s right for them.

    Like any other opioids, Suboxone does come with the risk of addiction, especially when it’s misused. Suboxone does have a lower risk of abuse than Methadone but abuse still does happen. Signs of an Suboxone addiction include:

    • Slurred speech
    • Poor coordination
    • Extreme drowsiness
    • Nausea
    • Muscle pain
    • Watery eyes
    • Vomiting and/or diarrhea

    It is possible to take too much of the medication which can result in shallow breathing, shaking, pounding heartbeat, stomach pain, and blurred vision.

    Some behavior symptoms of Suboxone addiction are:

    • Loss of interest in activities
    • Isolating yourself
    • Sleeping excessively or not being able to sleep at all
    • Stealing to pay for the mediation
    • Obsessively thinking about using Suboxone
    • Lying and manipulating to get the medication

    The withdrawal process from a suboxone addiction can be rough and should be done under the care of a doctor, such as at a rehabilitation center.  

    Suboxone is meant to be taken as a replacement to other narcotics. Patients should never combine this medication with other opioids because it can increase the risk of severe side effects and even death.

    Suboxone Interactions: What Should You Avoid Taking with Suboxone?

    You should make sure your doctor knows about all the medications and herbal remedies you take during your initial appointment. Suboxone can interact with many types of medications so your doctor may suggest stopping one medication or switching to a different medication before taking it.

    Some of the most common medications that can cause interactions with Suboxone include:

    • Iron products
    • Anxiety medications
    • Antidepressants
    • Antifungals
    • Acetaminophen
    • Cholesterol-lowering medications
    • HIV medications, or protease inhibitors

    Taking Suboxone while consuming alcohol is not recommended as it could lead to breathing difficulties and even death. The buprenorphine and alcohol both work as depressants of the central nervous system, so combining the two can lead to:

    • Nausea
    • Decreased motor coordination
    • Increased sweating
    • Heart palpitations
    • Decreased blood pressure
    • Decreased blood flow
    • Altered thoughts

    The dangers of drinking alcohol while taking this medication are many, which is why patients should discuss their alcohol use with their doctor ahead of time.

    The ingredients in Suboxone are meant to block the effects of other drugs. This can increase the risk of an overdose because a patient may take more of a drug combined with Suboxone in an effort to feel the effects.

    Suboxone Withdrawal Symptoms

    Anytime a narcotic medication is used for a lengthy time, it can cause a mental or physical dependence. This means that if a patient stops taking the medication, they’ll likely experience withdrawal symptoms.

    It’s never a good idea to quit any medication “cold turkey” without being under the care of a physician. Some patients, however, do decide to stop taking Suboxone without a doctor’s guidance and can end up with withdrawal symptoms that can last several months.  

    Some symptoms of Suboxone withdrawal include:

    • Drug cravings
    • Anxiety
    • Depression
    • Insomnia
    • Lethargy
    • Muscle aches
    • Headaches
    • Nausea and/or vomiting
    • Difficulty concentrating
    • Fever
    • Chills
    • Irritability

    The worst part of the withdrawal symptoms will come around 72 hours of the last dose of Suboxone. After week two, most patients will still have depression and cravings.

    To get off Suboxone safely, doctors work with patients to develop a plan that decreases the dose over a determined amount of time in a method called tapering. How much of a reduction and how often greatly depends on the patients, but it’s typically no more than a reduction of 4 milligrams per day.

    Since every patient is different, it can take a week to several months to taper down Suboxone until a patient is no longer dependent on it.

    Suboxone Efficacy: What Does Suboxone Do for Your Symptoms?

    Suboxone and other opioids both work in the same region of the brain. The buprenorphine works to prevent cravings for other opioids while patients go through detox.

    The naloxone is an ingredient in Suboxone that prevents individuals from abusing the medication. If someone were to dissolve or inject Suboxone, they can end up going into instant withdrawal.

    When taking Suboxone as prescribed, patients have a chance to slowly and safely wean themselves from all opioids, eventually kicking the addiction. This medication also makes it possible to live a normal life, get a job, go to school, and be more productive because they’re not constantly sick with withdrawal symptoms.  

    Suboxone evaluations are performed confidentially in a doctor’s office. Patients are prescribed this medication and can take it in the comfort of their homes.

    This is beneficial because patients do not have to take time to go to a clinic every day for medication. Suboxone also prevents the need to go to a rehabilitation center, which results in providing more time for patients to live productively.  

    Suboxone and Pregnancy

    If you become pregnant while taking Suboxone, you should consult with your doctor to determine what the next best course of action to take is. Any type of medication you take can have an effect on a growing fetus and impact it in a negative way.

    Opioid withdrawal can be harmful and even deadly to a fetus, so it is best to not stop taking the medication without talking to your doctor first.

    At this time, the Federal Drug Administration puts Suboxone in the C category of pregnancy risk medication. This means that there just isn’t enough research performed on human subjects to determine that Suboxone is a completely safe medication to use while pregnant.

    Category C can mean that during animal production studies, there were adverse effects on the fetus. The potential benefits of using Suboxone could end up outweighing the risks, which is why some doctors may have a pregnant woman continue Suboxone treatment.

    The risks of taking Suboxone or other opioids while pregnant determined by the Centers for Disease Control and Prevention include:

    • Stillbirth
    • Preterm delivery
    • Congenital heart defects
    • Neonatal Opioid Withdrawal Syndrome, or NOWS
    • Neural Tube Defects

    Neonatal Opioid Withdrawal Syndrome can occur if a fetus is exposed to opioids while they’re in the womb. When the baby is born, it can go through withdrawals. Some symptoms of NOWS are:

    • Fever
    • Trouble sleeping
    • Diarrhea and/or vomiting
    • Poor feeding
    • Slow weight gain
    • Tremors and/or seizures
    • Excessive crying
    • Breathing problems
    • Sneezing

    Other possible risks include glaucoma, spina bifida, hydrocephalus, and gastroschisis. Because of the risks associated with continued Suboxone use during pregnancy, it is highly recommended to only take it as directed by your doctor.

    Your doctor will look at your history and will consider all options to determine if continuing Suboxone is the best option during pregnancy. If a patient struggles with an addiction to heroin, a doctor may prescribe Suboxone because it’s a lot safer to the patent and the fetus.

    Clinical Trials

    A 2003 study in Sweden over the course of one year evaluated patients with heroin dependence in combination with buprenorphine and intensive psychosocial therapy. These individuals were all 20 years of age and older and did not meet the legal criteria to go on the Methadone treatment program.

    The study showed that 75 percent of urine screens were negative for other opiates, cannabinoids, benzodiazepines, and central stimulants. The results showed that Suboxone is an effective treatment for those with an addiction to heroin.

    Another study determined if a 7-day taper schedule or 28-day schedule would more effective at preventing relapse and curbing the effects of withdrawal.

    The data from this study was collected at the conclusion of the tapering schedule and at the one and three mark follow up. This study was performed in ten cities in 11 different outpatient programs.

    The study concluded that there is no difference between a short taper period of seven days versus an extended one of 28 days. Patients do not have any advantage over choosing the longer tapering schedule.

    Suboxone Manufacturers

    Reckitt Benckiser Pharmaceuticals Inc. is the manufacturer of Suboxone, as well as approximately 60 other medications in the United States.

    The Food and Drug Administration, or FDA, approved for generic version of Suboxone, which can be a cost-effective solution to individuals who cannot afford Suboxone. Suboxone can run patients around $10 a film, which does add up if they do not have health insurance.

    The generic form of suboxone will simply be called buprenorphine and naloxone and is expected to be produced by Dr. Reddy’s Laboratories SA and Mylan Technologies Inc. As of February 2019, there’s no information about when the generic versions will be released.

    FDA Approval Status of Suboxone

    The FDA approved Suboxone for the use of treating opioid addiction in October 2002. It is a Schedule III narcotic controlled substance. Other types of Schedule III narcotics also include Tylenol with over 90 milligrams of codeine.

    Being a schedule 3 means that these medications have a lower potential risk for abuse than schedules 1 and 2.

    Related Drugs or Medications

    Methadone is another medication that has similarities to Suboxone. Methadone is primarily used for chronic pain and opioid addiction while Suboxone helps patients with opioid dependence.

    There are a few forms of Methadone including an oral tablet, oral concentrate, injectable solution, or an oral dispersible tablet.

    This medication falls into a Schedule 2 class, meaning it has more of a potential to be abused than Suboxone. Patients that are prescribed to take Methadone must go to approved clinics daily to receive their doses, while Suboxone patients can take theirs at home.

    Naltrexone, or Vivitrol, is another medication used to treat opioid dependence. This type of medication comes in the form of a daily pill. Naltrexone is only used on patients that have already been through full detoxification, but once detoxed, it can produce similar results to Suboxone.

    Zubsolv is another medication that uses the combination of buprenorphine and naloxone to treat opioid dependence. This type comes in a tablet form and lasts for a similar amount of time as Suboxone.

    Zubsolv comes in various dosages, starting with 0.7/0.18 milligrams and going up to 11.4/2.9 milligrams. Doctors will typically start patients off at the lowest dose and then go up as needed to provide the best results.

    Subutex is another alternative, using Buprenorphine to treat opioid addiction and prevent withdrawal symptoms.  This medication comes in a tablet form and is placed under the tongue until it dissolves, which takes around 5 to 10 minutes.

    Subutex doesn’t have the opioid-blocking effects of Suboxone because it doesn’t contain naloxone, but it acts like an opioid that produces mild effects.  

    When used as prescribed by a healthcare professional, Suboxone can help eliminate withdrawal symptoms. This medication can also provide a better quality of life for those suffering from addiction because they have a chance to slowly taper down their dose until they’re no longer dependent on opioids.

    Always take the time to fully discuss the pros and cons of taking a medication such as Suboxone with your physician.