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Buprenorphine/naloxone, sold under the brand name Suboxone among others, is a fixed-dose combination medication that includes buprenorphine and naloxone. It is used to treat opioid use disorder and reduces the mortality of opioid use disorder by 50% (namely by reducing the risk of overdose on full-agonist opioids such as heroin or fentanyl).It relieves cravings for use and withdrawal symptoms. Buprenorphine/naloxone is available for use in two different forms, under the tongue or in the cheek.

Side effects may include respiratory depression (decreased breathing), small pupils, sleepiness, and low blood pressure. The risk of overdose with buprenorphine/naloxone (unless combined with other sedating substances) is exceedingly low and lower than with methadone. However, people are more likely to stop treatment on buprenorphine/naloxone than methadone. Buprenorphine (like methadone) is a treatment option during pregnancy.

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. Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication, sometimes called a narcotic. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Buy Suboxone pills online without a prescription here.

Uses

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HOW TO USE

This medicine may be habit-forming. Never share this medicine with another person. Use dry hands when handling a Suboxone sublingual tablet or film. Drink a glass of water to moisten your mouth. Place the sublingual tablet or sublingual film under the tongue and allow it to dissolve. Place the buccal film in your mouth against the inside of your cheek and allow it to dissolve. Do not chew or cut a tablet or film, and do not swallow it whole. Buy Suboxone pills online without a prescription

Medical Use (Buy Suboxone pills)

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Buprenorphine/naloxone is used for the treatment of opioid use disorder. Long-term outcomes are generally better with the use of buprenorphine/naloxone than attempts at stopping opioid use altogether. This includes a lower risk of overdose with medication use. Due to the high binding affinity and low activation at the opioid receptor, cravings and withdrawal for opioids are decreased while preventing a person from getting high and relapsing on another opioid. The combination of the two medications is preferred over buprenorphine alone for maintenance treatment due to the presence of naloxone in the formulation, which helps discourage intravenous use.

Buprenorphine/naloxone is effective for treating opioid dependence and serves as a recommended first-line medication according to the U.S. National Institute on Drug Abuse. The medication is an effective maintenance therapy for opioid dependence and has generally similar efficacy to methadone, which is substantially more effective than abstinence-based treatment.

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Because it may be prescribed out of an office setting (as opposed to methadone which requires specialized centers), buprenorphine/naloxone allows for more freedom of administration for the person. It also thus comes with more risks in this vulnerable population. Buprenorphine/naloxone may be recommended for socially stable people who use opioids who may not be able to retrieve medications from a center daily, who may have another condition requiring regular primary care visits, or who may have jobs or daily lives that require they maintain all their faculties and cannot take a sedating medication.Buprenorphine/naloxone is also recommended over methadone in people who may be at high risk of methadone toxicity, such as the elderly, those taking high doses of benzodiazepines or other sedating substances, concomitant alcohol use disorder, those with a lower level of opioid tolerance, and those at high risk of prolonged QT interval. It is also helpful to use the medication in combination with psychosocial support and counseling for the person.

Available forms

Buprenorphine/naloxone is available in sublingual formulations (that is, products that are dissolved under the tongue). There is no evidence that the tablet formulation is easier to divert and use in ways other than intended by the prescriber compared to the film formulation, or that the tablet formulation has a higher risk for accidental ingestion by children.  There are various pharmacokinetic differences between sublingual formulations

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How should I take Suboxone?

Use Suboxone exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Never use Suboxone in larger amounts or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

Before taking a Suboxone sublingual film, drink water to moisten your mouth. This helps the film dissolve more easily. Place one film on the inside of your right or left cheek. If your doctor tells you to take 2 films at a time, place the other film on the inside of the opposite cheek. Keep the films in place until they have completely dissolved. If your doctor tells you to take a third film, place it on the inside of your right or left cheek after the first 2 films have dissolved.

While the film is dissolving, do not chew or swallow the film because the medicine will not work as well.

Suboxone sublingual tablets should be placed under the tongue until they dissolve.

Never share Suboxone with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine in a place where others cannot get to it. Selling or giving away Suboxone is against the law.

If you switch between medicines containing buprenorphine, you may not use the same dose for each one. Follow all directions carefully.

Do not stop using Suboxone suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

You will need frequent blood tests to check your liver function.

All your medical care providers should know that you are being treated for opioid addiction and that you take Suboxone. Make sure your family members know how to provide this information in case they need to speak for you during an emergency.

Never crush or break a Suboxone sublingual tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death.

Store Suboxone at room temperature, away from moisture and heat. Store the films in the foil pouch. Discard an empty pouch in a place children and pets cannot get to.

Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

Do not keep leftover opioid medication. Just one dose can cause death if someone uses this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, remove any unused films from the foil pack and flush the films down the toilet. Throw the empty foil pack into the trash.

Suboxone side effects

Get emergency medical help if you have signs of an allergic reaction to Suboxone: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Suboxone can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue-colored lips, or if you are hard to wake up.

Call your doctor at once or seek emergency medical attention if you have:

• weak or shallow breathing, breathing that stops during sleep;
• a light-headed feeling, like you might pass out;
• confusion, loss of coordination, extreme weakness;
• blurred vision, slurred speech;
• liver problems – upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• high levels of serotonin in the body – agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea;
• low cortisol levels – nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or
• opioid withdrawal symptoms – shivering, goose bumps, increased sweating, feeling hot or cold, runny nose, watery eyes, diarrhea, muscle pain.

Serious breathing problems may be more likely in older adults and those who are debilitated or have wasting syndrome or chronic breathing disorders.

Common Suboxone side effects may include:

• dizziness, drowsiness, blurred vision, feeling drunk, trouble concentrating;
• withdrawal symptoms;
• tongue pain, redness, or numbness inside your mouth;
• nausea, vomiting, constipation;
• headache, back pain;
• fast or pounding heartbeats, increased sweating; or
• sleep problems (insomnia).

This is not a complete list of side effects and others may occur. 

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