Buprenorphine for Opioid Recovery

Buprenorphine is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with moderate to severe opioid use disorder.

How Buprenorphine Works and How It’s Taken

Buprenorphine works on opioid receptors in the body. It partly activates a receptor called the mu-opioid receptor and blocks another receptor called the kappa-opioid receptor. This can help lower cravings and ease withdrawal symptoms during opioid dependence treatment.

Doctors prescribe buprenorphine when a person needs treatment for opioid dependence. It is preferred when treatment is first started. Buprenorphine should be used as part of a complete treatment plan that includes counseling and other support.

Buprenorphine tablets are placed under the tongue and allowed to dissolve. Do not cut, chew, or swallow the tablets.

After the tablet has completely dissolved, take a sip of water, gently rinse it around your teeth and gums, and swallow. Wait at least one hour before brushing your teeth.

Typical Dosing for Opioid Dependence

Buprenorphine is taken as a single daily dose. The dose depends on the stage of treatment and how the person responds.

In one study, treatment started with 8 milligrams on day 1 and 16 milligrams on day 2.

When buprenorphine sublingual tablets are used for maintenance treatment, the dose is generally 4 milligrams to 24 milligrams per day. The dose may be adjusted based on the person’s response.

For people with severe liver impairment, the healthcare provider may reduce the starting dose and dose increases by half and monitor for signs of too much buprenorphine or overdose.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Buprenorphine Side Effects

In clinical studies of buprenorphine used to treat opioid dependence, some common side effects were reported in about 5 percent to 34 percent of people, depending on the study and dose. These include:

Headache
Insomnia (trouble sleeping)
Pain
Constipation
Nausea
Increased sweating

Serious Side Effects and Warnings

Buprenorphine can cause serious side effects that may require immediate medical attention. These include:

Life-threatening breathing problems — Symptoms include breathing that is slower than normal, severe sleepiness, confusion, or trouble staying awake.
Central nervous system depression (severe drowsiness) — Dangerous sedation can lead to coma, especially when buprenorphine is combined with alcohol, benzodiazepines, gabapentin (Neurontin) or pregabalin (Lyrica), other opioids, or other sedating medicines.
Addiction, misuse, and diversion — Buprenorphine is a controlled substance and can be misused.
Sudden opioid withdrawal — Withdrawal symptoms can happen if buprenorphine is taken too soon after other opioids.
Hypersensitivity (allergic reaction) — Symptoms include rash, hives, swelling of the face, wheezing, low blood pressure, or loss of consciousness.
Hepatitis or liver injury (liver problems) — Symptoms can include yellowing of the skin or eyes, dark urine, light-colored stools, nausea, or right-sided stomach pain.
Dental problems — These include cavities, tooth decay, dental infection, tooth fracture, or tooth loss.
QTc prolongation — This change in the heart’s electrical activity can raise the risk of abnormal heart rhythms in some people.
Orthostatic hypotension (low blood pressure when standing) — You may feel dizzy or faint when you stand up.
Sleep-related breathing problems — These include conditions such as central sleep apnea.
Raised cerebrospinal fluid pressure (increased pressure in the brain) — This can affect alertness and may be a concern after a head injury.
Increased intracholedochal pressure (pressure in the bile ducts) — This may worsen certain gallbladder or bile duct problems.
Effects in acute abdominal conditions — Buprenorphine may make it harder to recognize the cause of sudden stomach pain.
Neonatal opioid withdrawal syndrome — A newborn may have withdrawal symptoms if buprenorphine is used during pregnancy.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Buprenorphine

Before starting buprenorphine, your doctor will check your liver function with blood tests.

Tell your doctor if you have any allergies to buprenorphine or any of its ingredients.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Tell your doctor right away if you have problems with your teeth. Schedule regular dental checkups and tell your dentist that you are taking buprenorphine.

Do not drive, use heavy machinery, or do other dangerous activities until you know how buprenorphine affects you. It can make you sleepy, dizzy, or lightheaded and can slow your reaction time. Be especially careful when treatment is started or your dose is changed.

Do not drink alcohol or take medicines that contain alcohol while taking buprenorphine. Mixing alcohol with buprenorphine can cause severe drowsiness, loss of consciousness, breathing problems, or death.

Do not take buprenorphine if you have had a serious allergic reaction to it.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your next dose at the usual time. Do not take 2 doses at the same time unless your doctor tells you to.

Long-term opioid use may reduce fertility in males and females. It is unclear if this effect can be reversed.

Tell your doctor if you are pregnant or plan to become pregnant. A baby exposed to buprenorphine during pregnancy may have opioid withdrawal symptoms after birth. These symptoms can be serious if they are not recognized and treated.

Tell your doctor if you are breastfeeding or plan to breastfeed. Buprenorphine passes into breast milk. If you breastfeed, watch your baby for increased sleepiness or trouble breathing.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is buprenorphine for opioid dependence?

Clinical studies showed that buprenorphine helped people stay in treatment and reduced their use of other opioids. In a four-week study, people taking buprenorphine had more urine tests that were negative for opioids other than the study medication than people taking a placebo (an inactive treatment). In a 16-week study, the three higher doses tested were better than the 1 milligram dose at keeping people in treatment and reducing opioid use.

When is buprenorphine treatment started?

Buprenorphine treatment should begin when clear signs of moderate opioid withdrawal are present. For people who have been using short-acting opioids, the first dose should be taken no sooner than four hours after the last opioid use. For people who have been using methadone (Methadose) or another long-acting opioid, the first dose is generally taken no sooner than 24 hours after the last opioid use.

Does buprenorphine interact with other medicines?

Yes. Buprenorphine can interact with some medicines and substances. These interactions may increase side effects or change the amount of buprenorphine in the body.

Important interactions include:

Benzodiazepines and other medicines that slow the brain and breathing — These include sedatives, sleeping medicines, muscle relaxants, antipsychotic medicines, gabapentin, pregabalin, other opioids, and alcohol. Using them with buprenorphine can increase the risk of severe drowsiness, breathing problems, overdose, coma, and death.
Medicines that affect how buprenorphine is broken down — Some medicines can raise or lower buprenorphine levels. Examples include certain antibiotics, antifungal medicines, anti-seizure medicines, and HIV medicines.
Medicines that affect serotonin — These include some antidepressants and migraine medicines. Using them with buprenorphine may cause serotonin syndrome, which can be life-threatening.
Monoamine oxidase inhibitors (MAOIs) — Buprenorphine is not recommended while taking these medicines or within 14 days after stopping them.
Muscle relaxants — These can increase the risk of breathing problems.
Diuretics (water pills) — Opioids may make these medicines less effective.
Anticholinergic medicines — These may increase the risk of trouble urinating or severe constipation.

Before starting buprenorphine, tell your healthcare provider about all prescription medicines, over-the-counter medicines, vitamins, and herbal supplements you take. Your healthcare provider may need to monitor you or adjust your treatment.