BUPRENORPHINE SUBLINGUAL

GENERIC NAME(S): BUPRENORPHINE HCL

COMMON BRAND NAME(S): Subutex

 

Description

  • A mixed narcotic agonist-antagonist
    • Helps prevent withdrawal symptoms caused by stopping other opiate-type narcotics.
  • For treatment of dependence/addiction to narcotics (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 buprenorphine sublingual

  • Always refer to your doctors instructions before taking this medication. Duration and dosage will be determined by your medical condition and its response to the medication. Make sure to take this medication in the prescribed amount and time period even after symptoms disappear. Discontinuing the medication before completion of treatment may cause incomplete treatment of condition. If Symptoms persist, consult your doctor
  • Place under 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.
  • Usually used for the first 2 days after you have stopped all other narcotics. 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.
  • Best used when the first dose is started after signs of narcotic withdrawal have begun or at least 4 hours after last narcotic use.
    • can cause withdrawal symptoms if started too soon after your last narcotic use.
  • 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 this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.
  • May cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. Withdrawal symptoms may occur if you suddenly stop using this medication.
    • restlessness, watering eyes, runny nose, nausea, sweating, muscle aches
    • To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions right away.
  • Do not inject (“shoot up”) buprenorphine. Injecting it is dangerous and may cause severe withdrawal symptoms
  • Tell your doctor right away if you experience any withdrawal reactions.

Not available.

  • Minor side effects (if these symptoms persist or worsen, inform your doctor)
    • Drowsiness, dizziness, constipation, or headache
    • To prevent constipation, eat a diet adequate in fiber, drink plenty of water, and exercise. Consult your pharmacist for help in selecting a laxative (such as a stimulant type with stool softener)
    • To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
  •  Serious side effects (inform your doctor immediately)
    • Severe (possibly fatal) breathing problems can occur if this medication is abused, injected, or mixed with other depressants (such as alcohol, benzodiazepines including diazepam, other narcotics)
    • Mental/mood changes (such as agitation, confusion, hallucinations), stomach/abdominal pain
    • May rarely cause narcotic withdrawal symptoms
      • Diarrhea, severe mental/mood changes (such as anxiety, irritability, trouble sleeping), muscle stiffness or shakiness
        • More likely when starting treatment or if you have been using long-acting narcotics such as methadone
    • May rarely cause serious liver disease, with symptoms of:
      • : dark urine, persistent nausea/vomiting, yellowing eyes/skin, severe stomach/abdominal pain
  • Severe allergic reactions are rare. Get immediate medical help if you notice the following:
    • Rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing

Precautions

  • Inform your doctor
    • Allergy to the medication or any allergies
    • 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)
  • May cause dizziness or drowsiness
    • Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages. Alcohol also increases your risk for breathing problems.
  • May cause QT prolongation, a condition that affects the heart rhythm
    • Risk increases if you have the following conditions”
      • Heart problems, family history of certain heart problems
      • Low levels of potassium or magnesium
        • Usage of such as diuretics/”water pills” or presence of conditions such as severe sweating, diarrhea, or vomiting
  • Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
  • Elderly may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, slow/shallow breathing, and QT prolongation
  • 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.
  • Consult your doctor before breast-feeding as this medication passes into breast milk and may cause unwanted effects on your baby

 

Interactions

Taking multiple drugs may affect how medications work and/or cause unwanted side effects. List down all the medications you are taking and inform your physician and pharmacist. Do not take, discontinue, or alter any dose of medications without prior approval of your physician.

  • Products that may interact with this medication include:
    • narcotic antagonists (such as naltrexone), certain narcotic pain medications (mixed narcotic 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
  • The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if used with the following:
    • Alcohol, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and other narcotic pain relievers (such as codeine, hydrocodone)
  • 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 narcotics.

Overdose

If overdose is suspected, contact a poison control center or emergency room immediately.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and as soon as you remember, take a regular dose or if the time of the next dose is near, wait for it before taking another dose and resume your usual schedule. Do not increase the dose to compensate for the missed dose.

Storage

  • Room temperature
  • Do not expose to light and moisture
  • Do not store in the bathroom
  • Keep all medications away from pets and children
  • Do not flush medications 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
    • Consult your pharmacist or local waste disposal company for more details about how to safely discard your product

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