Generic Name & Formulations:

Buprenorphine (as HCl), naloxone (as HCl dihydrate); 2mg/0.5mg, 4mg/1mg, 8mg/2mg, 12mg/3mg; sublingual films; lime-flavor.

Addiction/dependence:
Indications for SUBOXONE 2mg:
Treatment of opioid dependence, as part of a complete treatment plan to include counseling and psychosocial support.
Adult Dosage:
Do not cut, chew or swallow. Avoid food or drinks until film dissolves. Give by sublingual (SL: under the tongue) or buccal (inside of cheek) administration. Place additional films sublingually or buccally on opposite sides from the first film if needed; should minimize overlapping.

Start when clear signs of withdrawal occur; individualize based on type and degree of opioid dependence. Supervised induction (use SL route): Day 1: initially 2mg/0.5mg or 4mg/1mg; may increase in increments of buprenorphine 2mg or 4mg at 2-hr intervals, up to 8mg/2mg based on response; Day 2: a single dose up to 16mg/4 mg. Dependent on heroin or short-acting opioids: initiate induction with either Suboxone 2mg film or buprenorphine monotherapy (SL tabs) at least 6hrs after the last opioid dose.

Dependent on methadone or long-acting opioids: initiate buprenorphine monotherapy (SL tabs) for induction, then transition to once daily Suboxone. Maintenance phase: (target dose): 16mg/4 mg once daily; adjust in 2mg/0.5mg or 4mg/1mg increments/decrements; (usual range): 4mg/1mg–24mg/6 mg once daily.

Switching between buprenorphine or buprenorphine/naloxone tabs and Suboxone 2mg films: start on the same dosage as previously; may need dose adjustments between products; monitor for over- or under-dosing.

Switching between various Suboxone 2mg film strengths: systemic exposures may be different; monitor for over- or under-dosing. Hepatic impairment (severe): not recommended; (moderate): avoid use for induction. Concomitant use or discontinuation of CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments.

SUBOXONE 2mg Warnings/Precautions:

Potential risk for opioid overdose; strongly consider prescribing naloxone when initiating and renewing therapy. Consider prescribing naloxone if the patient has household members (eg, children) or other close contacts at risk of accidental ingestion or overdose. Abuse potential (monitor).

Risk of significant respiratory depression; monitor. Compromised respiratory function (eg, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, pre-existing respiratory depression). Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. Unintentional pediatric exposure. Adrenal insufficiency.

Obtain LFTs at baseline then monitor periodically; evaluate if hepatic event is suspected. Opioid-naïve. Elevated CSF pressure (eg, head injury, intracranial lesions). Biliary tract dysfunction. Acute abdomen. CNS depression. Moderate and severe hepatic impairment. Drug abusers.

Reevaluate periodically. Avoid abrupt cessation. Elderly. Labor & delivery: may need additional analgesia. Pregnancy/postpartum: may need dose adjustments; monitor closely for withdrawal. Potential neonatal opioid withdrawal syndrome during prolonged use. Nursing mothers: monitor infants.

See Also:
Buprenorphine Sublingual Tablets
Suboxone 2mg Classification:
Opioid (partial agonist-antagonist) + opioid antagonist.

SUBOXONE 2mg Interactions:
Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); manage concomitant use as clinically appropriate and closely monitor; strongly consider prescribing Suboxone 2mg if concomitant use is warranted.

During or within 14 days of MAOIs: not recommended. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Concomitant NNRTIs (eg, efavirenz, nevirapine, etravirine, delavirdine) or PIs (eg, atazanavir with/without ritonavir): monitor and reduce buprenorphine/naloxone dose, if needed.

Potentiated by CYP3A4 inhibitors (eg, macrolides, azole antifungals, protease inhibitors). Antagonized by CYP3A4 inducers (eg, rifampin, carbamazepine, phenytoin). May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics.
Adverse Reactions:
Oral hypoesthesia, glossodynia, oral mucosal erythema, headache, nausea, vomiting, hyperhidrosis, constipation, withdrawal signs/symptoms, insomnia, pain, peripheral edema; respiratory depression, orthostatic hypotension, hepatitis, hypersensitivity reactions.

Overdose
Symptoms of overdose may include: slow/shallow breathing, slow heartbeat, coma.
Notes
Do not share Suboxone 2mg with others. Sharing it is against the law.

Tell all of your doctors that you use this medication and have regularly used opioids, especially in cases of 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, urine drug screening) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose
If you miss a dose of Suboxone 2mg, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage
Store in a secure place at room temperature away from light and moisture. Do not store it in the bathroom. Keep all medications away from children and pets.

Do not flush Suboxone 2mg down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. For more details, read the Medication Guide, or consult your pharmacist or local waste disposal company.