Buprenorphine/Naloxone

About Buprenorphine/Naloxone

Buprenorphine is a partial opioid agonist that prevents withdrawal symptoms. The naloxone does little when the medicine dissolves in the mouth as intended; it is there because injecting the product can bring on withdrawal. The first dose is taken only once withdrawal has clearly begun, since taking it too soon after another opioid can trigger sudden withdrawal.

Headache, nausea, sweating, constipation, poor sleep and a numb or sore mouth are common. There is no boxed warning, but benzodiazepines, alcohol and other sedatives can slow breathing dangerously; the label says treatment should not be refused because of them, but the prescriber needs to know. Liver tests are advised. One dose can cause life-threatening breathing problems in a child or anyone who does not use opioids. In pregnancy, untreated opioid use disorder carries its own risks, and newborns may have withdrawal that the label calls expected and treatable.

Since the Consolidated Appropriations Act, 2023 ended the separate federal waiver, any clinician whose DEA registration covers Schedule III drugs can prescribe it, as state law allows, with no federal patient cap. DEA rules also allow it to be started through a telemedicine visit, including by phone. Federal law does not limit how much buprenorphine a pharmacy orders or dispenses, though wholesalers may set their own ordering thresholds, which the DEA and HHS have asked them to review.

Taking Buprenorphine/Naloxone

How to take it

Usually once a day. Let the film or tablet dissolve completely under the tongue (films can also go inside the cheek); do not cut, chew or swallow it, or eat or drink until it has dissolved. Then sip water, swish it around your teeth and gums and swallow, and wait at least an hour before brushing, which helps protect your teeth.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule.

Storage

At room temperature in the original packaging, films in their child-resistant pouches, kept securely out of reach of children and others. Take unused doses to a drug take-back program.

Interactions to know about

Benzodiazepines, sleep medicines, alcohol and other sedatives add to its effect on breathing. Erythromycin, ketoconazole and ritonavir can raise its levels; rifampin, carbamazepine and phenytoin can lower them. With antidepressants, triptans and other serotonin-affecting drugs it has caused serotonin syndrome.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Buprenorphine/Naloxone differs from pharmacy to pharmacy

Films and tablets are not swapped at the counter, since blood levels can change on switching. In federal acquisition-cost data, generic films cost pharmacies more than generic tablets of the same strength, and brand Suboxone film and Zubsolv cost far more. Strengths are not priced evenly per milligram either, so how a daily dose is made up changes its price.

Ways to pay less for Buprenorphine/Naloxone without insurance

• Ask the prescriber to allow generic substitution, and whether a generic tablet would suit you as well as a film.
• Ask the pharmacy to quote the strength combinations your prescriber is willing to write.
• If Zubsolv is prescribed, ask the manufacturer whether it offers a savings program, and the prescriber whether a generic would work.
• Confirm stock before the prescription is sent; an electronic prescription for a controlled medicine can be transferred only once before it is filled.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Buprenorphine/Naloxone

1. 1.Is this a film, a generic tablet or Zubsolv, at the strength intended?
2. 2.Which withdrawal symptoms should I wait for before my first dose?
3. 3.Is it safe with my medicines for anxiety, sleep, pain or depression?
4. 4.Can you dispense naloxone, and how many refills does my prescription allow?
5. 5.If I need surgery or pain treatment, what should I tell the clinicians?

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