Subutex Vs. Suboxone

Subutex Vs. Suboxone

Subutex (buprenorphine) and Suboxone (buprenorphine/naloxone) 

Subutex and Suboxone are two medicines approved by the food and drug administration (FDA) for use in treating opioid use disorder (OUD). 

Individuals who become dependent on opioids can work with a qualified medical professional to determine which medications are best for them. This post will touch on recognizing some differences between Subutex and suboxone.

Dosing options

Subutex:  Subutex is a brand name that has been discontinued from manufacturing; however, there are generic manufacturers producing a generic version of the name brand Subutex.

Dosing for Subutex in the form of a sublingual tablet which comes in 2 mg (buprenorphine) and 8 mg (buprenorphine) dosing strengths. 

Suboxone: Suboxone is also a brand name.  Suboxone brand name still exists with Suboxone (buprenorphine/ naloxone) sublingual film. There are also generic manufacturers that make the (buprenorphine / naloxone) product.  Suboxone has four dosing forms and strengths. (Buprenorphine 2mg/nalxone 0.5mg  – – Buprenorphine 4mg/nalxone 1mg – – Buprenorphine 8mg/nalxone 2 mg – -Buprenorphine 12mg/nalxone 3 mg).  

Although there are more dosing forms/strengths with Suboxone sublingual film, sometimes the availability and cost impacts the ability for a patient to access them.  The Buprenorphine 2mg/nalxone 0.5mg and Buprenorphine 8mg/nalxone 2 mg dosing options are the most commonly used.

Dosing for Suboxone (brand or generic) is also sublingual.

Method of Ingestion

Both Subutex and suboxone are dosed sublingually. Sublingual means…under the tongue.  It is important that Subutex and suboxone are administered correctly to get maximum effect. Swallowing Subutex or suboxone will not provide the intended results.

It is important to understand that dissolve time does not always equal absorption time.  All individuals will absorb doses differently but a rule of thumb is that a patient places the dose under the tongue on either side of the mouth and holds the medication in place for at least 10 minutes.  During this time, the patient should refrain from talking, drinking, spitting, chewing, and minimizing swallowing as much as possible. Such movements of the mouth may adjust the dose away from the absorption placement and impact the amount of medication absorbed.

Because there are many manufacturers (generic and brand), the dissolution and absorption time may vary from product to product.  It is a best practice to try to always get the same manufacturer of the product you are taking.

Use with Benzodiazepines

Use caution when taking Subutex while taking benzodiazepines or other CNS depressants. Patients should be warned against concomitant self-administration /misuse. 

Use caution when taking suboxone while taking benzodiazepines or other CNS depressants.  Patients should be warned against concomitant self-administration /misuse. 

Patients who are being prescribed benzodiazepines along with a buprenorphine product should have an in-depth conversation with their doctor to establish best practices.

Accessibility

Accessibility often depends on the manufacturers.  Both Subutex and suboxone are usually readily available to pharmacies.  Certain pharmacies may not carry either medication on hand or they may operate by the “next day availability” standard, so always contact your pharmacy about 5 days before needing your doses to ensure they have them available for you. 

Often, your insurance provider will determine which medication is approved for your plan.  This may determine if the doctor prescribes Subutex or suboxone.  

At times, doctors, based on their understanding of the differences between these two medications and their understanding of addiction, may have a preference for prescribing one vs. the other. It is smart to engage in a conversation with your doctor as to why they are prescribing one vs. the other.

Cost

Because of the wide variety of manufacturers for both Subutex and suboxone, as well as the purchasing price of one pharmacy vs. the other, the cost will vary from pharmacy to pharmacy. It is a good practice to call a minimum of 3 pharmacies to compare the cost.

Another determining factor is the dose you have been prescribed.  Certain doses will cost more than other doses and the higher the dose, generally, the more it will cost.

And finally, cash pay vs. insurance can determine the cost to you.  Depending on your insurance plan, you may have to pay a copay.  On the other hand, if you are paying out of pocket (not using insurance) the cost will be fully absorbed by you.

Adherence

Taking the medication consistently and following the manufacturer’s suggested uses will improve the effectiveness of the medication(s). 

All doctors who can prescribe buprenorphine for its on-label use have to complete a series of qualifying training(s) which helps to create consistency in the guidance they will give to you. 

Withdrawal

Buprenorphine is a partial agonist at the mu-opioid receptor and chronic administration produces physical dependence on the opioid type, characterized by withdrawal signs and symptoms upon abrupt discontinuation or rapid taper. 

The withdrawal syndrome is typically milder than seen with full agonists and may be delayed in onset. When discontinuing SUBOXONE sublingual film, gradually taper the dosage.

If you are experiencing withdrawal symptoms while taking Subutex or suboxone, meet with your doctor as soon as possible to establish a stable dose.  Also, review proper dosing guidelines to ensure you are taking the medication properly to receive the optimal effects. 

Stopping Treatment 

The decision to discontinue therapy with SUBOXONE or SUBUTEX after a period of maintenance should be made as part of a comprehensive treatment plan. Both gradual and abrupt discontinuation of buprenorphine has been used, but the data are insufficient to determine the best method of dose taper at the end of treatment. 

Please refrain from self dosing or self tapering as these should be part of your comprehensive plan with your doctor or treatment facility.

A simple google search for subutex or suboxone product insert will give you all the information regarding these two products.

We are happy to provide you guidance and support, contact us today to further your understanding of these medications.

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