Buprenorphine/naloxone

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What Is Buprenorphine/naloxone?[edit | edit source]

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What are the uses of this medicine?[edit | edit source]

  • Buprenorphine is in a class of medications called opioid partial agonist-antagonists and naloxone is in a class of medications called opioid antagonists.
  • This medicine work to prevent withdrawal symptoms when someone stops taking opioid drugs by producing similar effects to these drugs.
  • Buprenorphine and naloxone sublingual tablets should be used as part of a complete treatment plan that includes counseling and psychosocial support.

How does this medicine work?[edit | edit source]

  • Buprenorphine is a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor.
  • Naloxone is an opioid antagonist and produces opioid withdrawal signs and symptoms in individuals physically dependent on full opioid agonists when administered parenterally.

Who Should Not Use this medicine ?[edit | edit source]

This medicine cannot be used in following condition:

  • Hypersensitivity to buprenorphine or naloxone.
  • Buprenorphine/naloxone products are not recommended in patients with severe hepatic impairment and may not be appropriate for patients with moderate hepatic impairment.

Is this medicine FDA approved?[edit | edit source]

  • The combination formulation was approved for medical use in the United States in October 2002, and in the European Union in November 2017.
  • A generic version was approved in the US in June 2018.
  • In 2017, it was the 288th most commonly prescribed medication in the United States, with more than one million prescriptions.

How should this medicine be used?[edit | edit source]

  • Buprenorphine and naloxone sublingual tablets are administered sublingually as a single daily dose.
  • Buprenorphine and naloxone sublingual tablets must be administered whole.
  • Do not cut, chew, or swallow buprenorphine and naloxone sublingual tablets.
  • Advise patients not to eat or drink anything until the tablet is completely dissolved.
  • Buprenorphine and naloxone sublingual tablets should be placed under the tongue until it is dissolved.
  • The recommended target dosage of buprenorphine and naloxone sublingual tablets for maintenance is 16 mg/4 mg.

What are the dosage forms and brand names of this medicine?[edit | edit source]

This medicine is available in fallowing dosage forms:

  • buprenorphine 2 mg/ naloxone 0.5 mg and
  • buprenorphine 8 mg/ naloxone 2 mg.

This medicine is available in fallowing brand names:

  • Bunavail® (containing Buprenorphine, Naloxone)
  • Suboxone® (containing Buprenorphine, Naloxone)
  • Zubsolv® (containing Buprenorphine, Naloxone)

What side effects can this medication cause?[edit | edit source]

Common possible side effects of this medicine include:

signs and symptoms of withdrawal include:

What special precautions should I follow?[edit | edit source]

  • Buprenorphine can be abused in a similar manner to other opioids.
  • Multiple refills should not be prescribed early in treatment or without appropriate patient follow-up visits.
  • Store buprenorphine and naloxone sublingual tablets safely out of the sight and reach of children.
  • Buprenorphine can cause severe, possibly fatal, respiratory depression in children.
  • Concomitant use of buprenorphine and benzodiazepines or other CNS depressants increases the risk of adverse reactions including overdose and death.
  • When discontinuing buprenorphine and naloxone sublingual tablets, gradually taper the dosage.
  • If adrenal insufficiency is diagnosed, treat with physiologic replacement of corticosteroids, and wean patient off of the opioid.
  • If treatment is temporarily interrupted or discontinued, monitor patients for withdrawal and treat appropriately.
  • Monitor liver function tests prior to initiation and during treatment and evaluate suspected hepatic events.

What to do in case of emergency/overdose?[edit | edit source]

The signs and symptoms of overdosage include:

  • include pinpoint pupils
  • sedation
  • hypotension
  • respiratory depression
  • death
  • Oxygen, IV fluids, vasopressors, and other supportive measures should be employed as indicated.
  • In the case of overdose, the primary management should be the re-establishment of adequate ventilation with mechanical assistance of respiration, if required.

Can this medicine be used in pregnancy?[edit | edit source]

  • If this medicine is used regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth.

Can this medicine be used in children?[edit | edit source]

  • The safety and effectiveness of buprenorphine and naloxone sublingual tablets have not been established in pediatric patients.
  • This product is not appropriate for the treatment of neonatal abstinence syndrome in neonates, because it contains naloxone, an opioid antagonist.

What should I know about storage and disposal of this medication?[edit | edit source]

  • Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].
  • Dispense in a tight, light-resistant container as defined in USP.
  • Store Buprenorphine and Naloxone Sublingual Tablets USP securely and dispose of properly



Buprenorphine/naloxone Resources
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Buprenorphine/naloxone Resources
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Contributors: Prab R. Tumpati, MD