Suboxone is the buprenorphine and naloxone sublingual tablets. It contains buprenorphine HCI ( a partial agonist at the mu-opioid receptor) and naloxone HCI dihydrate (an opioid receptor antagonist), in the ratio of 4:1.
The sublingual Suboxone tablets are available into strengths- 2mg (2mg buprenorphine and 0.5mg of naloxone) and 8mg (8mg of buprenorphine and 2mg of naloxone). The inactive ingredients of tablets are corn starch, lactose, povidone K30, mannitol, citric acid, magnesium stearate, sodium citrate, acesulfame K sweetener, FD&C Yellow No.6 color, and a lime/lemon flavor.
The common street names of Suboxone are subs, sobos, bupe, oranges, and stops. The street value of Suboxone sublingual tablets ranges from $15 to $20.
Uses of Suboxone –
Suboxone sublingual tablets help to treat opioid dependence. It addresses the narcotic addiction caused in the patients of prolonged opioid treatment. Counseling sessions and psychosocial support generally accompany the medication of Suboxone.
Buprenorphine is opioid acting on the brain while naloxone present in the medicine blocks the effects of narcotics, thus, preventing the feelings of calmness and well being caused by opioids that leads to its addiction and abuse.
The FDA (Food & Drug Administration) approves prescribing the use of Suboxone in the following cases:
Suboxone is a recommended treatment for opioid addiction. It helps reduce the opioid addiction by decreasing the dependence and withdrawal caused by the opioids.
Suboxone helps in reducing the opioid withdrawal symptoms as a part of the detoxification program. Opioid dependence treatment is a long term approach to reduce the patient’s dependence on opioids. On the other hand, the opioid detoxification is a short term program to ease and lessen the symptoms of opioid withdrawal.
Suboxone can be beneficial for patients having chronic pain and opioid dependence. It relieves the pain while treating the dependence of opioids.
Only the healthcare providers who meet the qualifying requirements under the Drug Addiction Treatment Act (DATA) codified at 21 U.S.C. 823(g) can give the prescription of Suboxone sublingual tablets in the treatment of opioid dependence.
Give the Suboxone tablets sublingually as a single daily dose. Adjust the dosage in increment or decrements of 0.5mg to 1mg of naloxone and 2mg to 4mg of buprenorphine.
The maintenance dosage ranges from 4mg to 24mg buprenorphine and 1mg to 6mg naloxone per day, as required by the patient.
The general dose of Suboxone tablet is 16/4mg buprenorphine/naloxone given as a single dose per day.
There is no maximum duration of the treatment. Some patients may require medicine indefinitely. Patients can continue using the medication as long as they are benefitting from Suboxone.
Method of Administration –
Take the Suboxone sublingual tablets as a whole. Do not swallow, chew, cut, or split the tablets. Place the tablet under the tongue and do not eat or drink anything until it dissolves.
For the doses of more than two tablets, either place all the tablets under the tongue at once or put two pills at a time and continue to hold the tablets until they completely dissolve.
Swallowing the Suboxone tablets reduces the bioavailability of the drug. Follow the proper method of administration to ensure the consistency in bioavailability.
Side Effects –
The adverse reaction by the Suboxone tablets include:
Addiction, Abuse, and Misuse.
Whole-Body: asthenia, chills, headache, back pain, abdominal pain, opioid withdrawal, hypersensitivity reactions, and neonatal opioid withdrawal syndrome.
Digestive System: constipation, diarrhea, vomiting, and nausea.
Nervous System: insomnia and CNS (Central Nervous System) depression.
Respiratory System: rhinitis and respiratory depression.
Addiction, Abuse, and Misuse:
Buprenorphine, an active ingredient in the Suboxone tablets, is a Schedule III controlled substance under the Control Substance Act (CSA). It can be abused illegally and illicitly, like other opioids. Prescribe the medication only to the patients who meet the criteria of the treatment through buprenorphine. Dispense the Suboxone tablets with precaution to prevent the risk of misuse, abuse, or theft. Do not prescribe multiple refills to a patient without appropriate follow-up visits.
Risk of Respiratory and CNS Depression:
Use Suboxone tablets with great caution in the patients of chronic obstructive pulmonary disease, decreased respiratory reserve, pre-existing respiratory depression, hypercapnia, hypoxia, cor pulmonale, and other respiratory dysfunctions. It can cause fatal respiratory distress and even death.
The misuse of Suboxone causes coma and death when taken with other CNS (Central Nervous System) depressants like alcohol, marijuana, and any alcoholic beverage.
The intentional or unintentional exposure of Suboxone to the children can cause life-threatening respiratory depression. Keep the Suboxone tablets out of the reach of children, and destroy the unused medication properly.
Like opioid medications, Suboxone can produce orthostatic hypotension in ambulatory patients.
The use of buprenorphine and naloxone causes hypersensitivity reactions such as angioneurotic edema, bronchospasm, and anaphylactic shock. The common signs and symptoms of hypersensitivity by Suboxone sublingual tablets include hives, skin rashes, and pruritus.
Risk of Opioid Withdrawal:
Abruptly discontinuing the medication of Suboxone tablets, like other narcotics, causes the opioid withdrawal. The withdrawal syndrome caused by the Suboxone is comparatively milder than full agonists (opioids). Gradually discontinue the doses to avoid withdrawal syndrome.