Subutex : Uses, Side Effects, Interactions & More

Uses

Buprenorphine is used to treat dependence/addiction to opioids. Buprenorphine belongs to a class of drugs called mixed opioid agonist-antagonists. It helps prevent withdrawal symptoms caused by stopping other opioids. It is used as part of a complete treatment program for drug abuse (such as compliance monitoring, counseling, behavioral contract, lifestyle changes).

How to use Subutex Tablet, Sublingual

Read the Medication Guide provided by your pharmacist before you start using sublingual buprenorphine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Use Subutex as directed by your doctor, usually once daily. Place the medication under your tongue for 5 to 10 minutes and let it dissolve completely. If you are prescribed more than one tablet each day, you may place all of the tablets under your tongue at once or place two tablets at a time under your tongue. Do not swallow or chew this medication. It will not work as well.

Buprenorphine alone is usually used for the first 2 days after you have stopped all other opioids. It is usually given in your doctor’s office. Your doctor will then switch you to the combination buprenorphine/naloxone medication for maintenance treatment. The combination with naloxone works the same way as buprenorphine alone to prevent withdrawal symptoms. It is combined with naloxone to prevent misuse (injection) of the medication.

Buprenorphine works best when the first dose is started after signs of opioid withdrawal have begun. Buprenorphine can cause withdrawal symptoms if started too soon after your last opioid use. Follow your doctor’s instructions for your treatment plan.

The dosage is based on your medical condition and response to treatment. Do not increase your dose, take the medication more frequently, or take it for a longer time than prescribed. Properly stop the medication when so directed.

Use Subutex regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.

Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.

Do not inject (“shoot up”) buprenorphine. Injecting it is dangerous and may cause severe withdrawal symptoms (see Side Effects section). Consult your doctor or pharmacist for more details.

Tell your doctor right away if your condition does not get better or if it gets worse.

Side Effects

It can cause drowsiness, dizziness, constipation, or headache. If any of these effects persist or worsen, tell your doctor or pharmacist immediately.

To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.

To reduce the risk of dizziness and lightheadedness, get up slowly when getting up from a sitting or lying position.

Remember that your doctor has prescribed Subutex because he or she has determined that the benefit to you is greater than the risk of side effects. Many people using this medicine do not have serious side effects.

Serious (possibly fatal) breathing problems can occur if this drug is abused, injected, or mixed with other depressants (such as alcohol, benzodiazepines, including diazepam, other opioids).

Tell your doctor right away if you have serious side effects, including: interrupted breathing during sleep (sleep apnea), mental / mood changes (such as agitation, confusion, hallucinations), stomach / abdominal pain, signs that the glands adrenals do not work well (such as unusual tiredness, weight loss).

Seek medical attention right away if any of these rare but serious side effects occur: fainting, fast / irregular heartbeat, severe dizziness, slow / shallow breathing, unusual drowsiness / difficulty waking up.

Although Subutex is used to prevent withdrawal reactions, it can rarely cause opioid withdrawal symptoms such as diarrhea, severe mental / mood changes (such as anxiety, irritability, trouble sleeping), muscle stiffness, or tremors. This is more likely when you first start treatment or if you have been using long-acting opioids such as methadone. If such symptoms occur, notify your doctor or pharmacist immediately.

In rare cases, Subutex can cause serious liver disease. Seek medical attention immediately if you have any symptoms of liver damage, including: dark urine, persistent nausea / vomiting, loss of appetite, yellowish eyes / skin, severe stomach / abdominal pain.

It is rare for a very serious allergic reaction to this drug. However, seek medical attention immediately if you notice any symptoms of a serious allergic reaction, including: rash, itching / swelling (especially of the face / tongue / throat), severe dizziness, difficulty breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the USA –

Call your doctor for medical advice on side effects. You can report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada: Call your doctor for medical advice on side effects. You can report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using Subutex, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using Subutex, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as head injury, tumor, seizures), breathing problems (such as asthma, sleep apnea, chronic obstructive pulmonary disease-COPD), liver disease, mental/mood disorders (such as confusion, depression), stomach/intestinal problems (such as blockage, constipation, diarrhea due to infection, paralytic ileus), difficulty urinating (such as due to enlarged prostate).

Subutex may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). Alcohol also increases your risk for breathing problems.

Buprenorphine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using buprenorphine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using buprenorphine safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, slow/shallow breathing, and QT prolongation (see above).

Before using Subutex, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Tell the doctor right away if you notice any symptoms in your newborn baby such as slow/shallow breathing, irritability, abnormal/persistent crying, vomiting, or diarrhea.

Subutex passes into breast milk and may rarely have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops unusual sleepiness, difficulty feeding, or trouble breathing. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: naltrexone, certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine).

Many drugs besides buprenorphine may affect the heart rhythm (QT prolongation), including amiodarone, disopyramide, dofetilide, ibutilide, procainamide, quinidine, sotalol, among others.

The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is used with other products that may also affect breathing or cause drowsiness. Tell your doctor or pharmacist if you are taking other products such as alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and other opioid pain relievers (such as codeine, hydrocodone).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Deaths have occurred when buprenorphine has been misused by injecting it (“shooting up”), especially when used in combination with benzodiazepines (such as diazepam) or other depressants such as alcohol or additional opioids.

Overdose

If someone has overdosed and has severe symptoms such as fainting or difficulty breathing, give naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canadian residents can call a provincial poison control center. Symptoms of an overdose may include: slow breathing, slow heart rate, loss of consciousness.

Notes

Do not share this medicine with others. Sharing it is illegal.

Tell all your doctors that you use this medicine and that you have used opioids regularly, especially for emergency treatment.

Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.

Laboratory and / or medical tests (such as liver function tests) should be performed periodically to monitor your progress or check for side effects. Check with your doctor for more details.

Missed dose

If you miss a dose, take it as soon as you remember. If it is close to the time for the next dose, skip the missed dose. Take your next dose at the usual time. Do not double the dose to catch up.

Storage

Keep in a room at room temperature away from light and moisture. Do not store in the bathroom. Keep all medicines out of the reach of children and pets.

Do not flush medications down the toilet or flush them down the drain unless instructed to do so. Properly dispose of this product when it is expired or no longer needed. For more details, read the Medication Guide or ask your pharmacist or local waste disposal company.

Disclaimer: DrLinex has made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses.