Suboxone is a medication used to treat opioid use disorder (OUD). This article will cover Suboxone’s side effects, how to manage them safely and where to turn for treatment.
Suboxone Basics: How the Medication Works
Suboxone is a combination of two other medications: buprenorphine and naloxone, used to treat opioid addiction.
How Suboxone Treats Opioid Use Disorder
Buprenorphine is a partial opioid agonist that works by relieving drug cravings and withdrawal symptoms without providing the high and dangerous effects that result from the use of other opioids.
Naloxone is an opioid antagonist, which means that it binds to opioid receptors in the brain, blocking opioids, including fentanyl, heroin, morphine and oxycodone from reaching the brain’s opioid receptors.
The buprenorphine in Suboxone has a “ceiling effect.” This phenomenon means that after taking a certain dose, taking more will not increase the effects of the drug.
For this reason, it helps to lower misuse or overdose risk, while still easing cravings and lessening withdrawal symptoms.
To understand how medications for opioid use disorder (or MOUD) can help, it is important to know the differences between physical dependence, tolerance and addiction.
Physical dependence vs. Addiction
Physical dependence occurs when the body has become accustomed to opioids being present in the system after long term use. When dependence has occurred, withdrawal will happen if use is abruptly lowered or ceased.
Physical dependence is not the same thing as addiction. Addiction is a chronic brain disease that involves physical dependence but also an inability to control drug use and other behavioral changes.
In addition significant interference with daily functioning is seen in addition to a loss of control, despite the ongoing harm it is causing.
Common Suboxone Side Effects
Several side effects can result from Suboxone use. These symptoms can range from mild to potentially life threatening.
Physical Side Effects
Short term physical side effects of Suboxone use can include:
- Nausea, vomiting and constipation
- Headaches
- Dizziness and fatigue
- Sweating
- Itching
- Anxiety and irritability
- Insomnia and/or vivid dreams
- Blurred vision
Less common short term side effects may include allergic reactions such as rash, itching, hives and swelling. If you experience any of these, prompt medical attention is strongly recommended.
Mouth, Dental and Skin Reactions
Both tablet and film forms of Suboxone can cause dental or other mouth problems such as burning, redness or small sores, cavities, tooth decay and infections. Suboxone should not be taken with sugary drinks.
When taking sublingual Suboxone, it is crucial to let the film fully dissolve before swallowing.
Also, always rinse with water afterward and wait before brushing to protect tooth enamel. Good oral hygiene should be practiced and regular dental visits are highly encouraged.
Less common among short term side effects may include allergic reactions such as rash, itching, hives, and swelling. If you experience any of these, prompt medical attention is strongly recommended.
Serious or Long Term Suboxone Side Effects
Suboxone can cause serious or long term side effects, including respiratory depression, liver, hormone, heart related risks and dependence.
Breathing Problems, Overdose, and Mixing with Other Drugs
Possible serious side effects of Suboxone are respiratory depression and overdose. These risks are higher in people with lung disease or when opiates have been mixed with alcohol, sleep medications, benzodiazepines and other forms of opioids.
Serious side effects that warrant immediate emergency care include severe drowsiness and difficulty staying awake.
Additionally, confusion, notably slowed breathing, blue lips or fingertips and unresponsiveness are potentially life threatening symptoms that require immediate medical attention.
Liver, Hormone and Heart Related Risks
Because Suboxone is metabolized in the liver, a person is at risk of developing or worsening liver disease, jaundice, elevated liver enzymes and hepatitis. This is especially true in people with a history of hepatic conditions or heavy alcohol use.
Medical professionals will do a baseline liver function test before initiating MAT and monitor levels periodically throughout the treatment to monitor for complications.
Other rare but serious long term side effects may occur.
These include:
- Adrenal insufficiency
- Orthostatic (or postural) hypotension
- Arrhythmia, fainting and chest pain
Long term use of Suboxone can also affect the body’s sex hormones.
Things to watch out for include:
- Menstrual cycle changes
- Fertility concerns
- Low testosterone
- Reduced libido
Always make sure to tell your medical provider about any side effects or complications you are experiencing during treatment.
Dependence, Tolerance and Suboxone Withdrawal
Physical dependence is not the same thing as the tolerance that develops after compulsive or long term opioid use.
Tolerance happens when the body gets used to the drug and requires higher amounts to feel the same effects, such as euphoria. This happens because repeated exposure to opioids changes how the brain’s receptors respond.
Because Suboxone works on opioid receptors, withdrawal symptoms can occur if doses are missed or if its administration is stopped abruptly.
However, they are usually milder than full opioid withdrawal symptoms, including stomach ache, flu like aches, difficulty sleeping and mood swings.
These symptoms highlight the need for medical supervision and a recovery focused treatment plan to reduce the risk of relapse in the future.
It is helpful to understand that being prescribed Suboxone does not equate to switching one addiction for another.
Suboxone is a critical component of a successful recovery plan that includes MAT, counseling, group support, relapse prevention planning and aftercare.
Managing Suboxone Side Effects Safely
Like most medications suboxone will have some side effects; however, you can take steps to manage these symptoms.
Everyday Strategies to Ease Mild Side Effects
There are several ways to manage and monitor the side effects you may experience when taking Suboxone.
You can keep a diary of side effects (time of dose, symptoms and their severity, etc.) to help communicate with medical providers about potential dose changes.
Self care strategies are also helpful. Ginger allays nausea; hydration and fiber can alleviate constipation; and adequate sleep and exercise can help to reduce other uncomfortable physical symptoms.
Always check with a doctor before starting any herbal supplements or over the counter medications.
It’s important to remember that these normally manageable side effects are often outweighed by the benefits, such as greater stability, reduced cravings and a lowered risk of overdose.
When to Call Your Prescriber or Change Your Plan
Symptoms that might indicate the need for a sooner than scheduled follow up appointment include worsening depression, severe insomnia, persistent GI issues and dental pain.
Symptoms that warrant URGENT medical attention include suicidal thoughts, chest pain, difficulty breathing or severe allergic reactions.
If any side effects are intolerable, your prescriber can make changes in your treatment plan, such as adjusting dosing, switching to another medication formulation, transitioning to a methadone treatment program or switching to an extended release naltrexone.
Never change doses or stop Suboxone without professional guidance. It is imperative to have regular medical check ins with lab monitoring and make sure all of your medical providers are aware of your treatment plan.
FAQs: Suboxone Side Effects
The duration and intensity of side effects vary based on factors such as dose, other medications being taken and mental and physical health. Most symptoms resolve within the first few days of treatment.
Suboxone can cause lightheadedness, drowsiness and slowed reaction times, especially early on in treatment or after dose changes. These symptoms can affect the ability to drive and operate machinery safely.
It is best to avoid these activities until you know how Suboxone will affect you and to follow employer policies and local laws.
Although it is more advisable to use Suboxone while pregnant than to have an opioid use disorder go untreated, it still requires individualized medical planning with both OB/GYN and addiction specialists.
Neonatal Abstinence Syndrome is a condition that occurs in newborns who were exposed to substances in the womb and who, after birth, may go into neonatal withdrawal. This is a known risk that can be both monitored and treated while taking Suboxone during pregnancy.
Decisions regarding breastfeeding, dose changes and the possibility of switching to methadone should be discussed with your medical team.
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