Bunavail (buprenorphine/naloxone)

Bunavail generic

Bunavail is a brand-name drug that contains two active ingredients: buprenorphine and naloxone. This combination of active ingredients is also available as a generic medication. A generic drug is an exact copy of the active ingredient in a brand-name medication. Generics are considered to be as safe and effective as the original drug. They tend to cost less than brand-name drugs.

Bunavail is discontinued and doctors no longer prescribe it. Instead, your doctor might prescribe a generic form of buprenorphine/naloxone. The generic form may come in slightly different strengths than Bunavail and may be taken in a slightly different way. Or your doctor may prescribe a brand-name form of buprenorphine/naloxone, such as Suboxone or Zubsolv.

Bunavail vs. Suboxone

Bunavail is discontinued and doctors no longer prescribe it. So you may wonder how Bunavail compares with other medications that are prescribed for similar uses. Here we look at how Bunavail compares to Suboxone.

Bunavail and Suboxone contain the same active ingredients: buprenorphine and naloxone. They’re both approved to treat opioid use disorder. They can cause similar side effects.

These drugs come in slightly different strengths and may be taken in different ways. For example, Bunavail and Suboxone both come as films that you place inside your cheek, where they dissolve. But you can also take Suboxone by letting the film dissolve under your tongue.

Your doctor may prescribe Suboxone instead of Bunavail, but they may prescribe a different dosage. To find out more about how these drugs compare, talk with your doctor or pharmacist.

Bunavail dosage

Bunavail is discontinued and doctors no longer prescribe it. Instead, they may prescribe a generic form of buprenorphine/naloxone. The dosage your doctor prescribes will depend on several factors. These include:

• the severity of your opioid use disorder and what opioid you’ve been taking
• what phase of treatment you’re in
• other medical conditions you may have
• the form of generic buprenorphine/naloxone your doctor prescribes

Generic forms of buprenorphine/naloxone come in slightly different strengths and may be taken in different ways than Bunavail.

The following information describes commonly used or recommended Bunavail dosages. This information does not apply to generic buprenorphine/naloxone. Your doctor will determine the best dosage of generic buprenorphine/naloxone to fit your needs.

Drug forms and strengths

Bunavail comes as a rectangular film that you place on the inside of your cheek. The drug is absorbed into your bloodstream through your cheek lining as the film dissolves. After putting Bunavail inside your cheek, you should not move the film with your tongue or finger.

Bunavail films were available in the following three strengths:

• 2.1 mg buprenorphine/0.3 mg naloxone
• 4.2 mg buprenorphine/0.7 mg naloxone
• 6.3 mg buprenorphine/1 mg naloxone

Dosage for opioid use disorder

There are two phases of treatment for opioid use disorder. The dosage your doctor prescribes depends on which phase you’re in.

Induction phase

This is the starting phase of treatment. It aims to manage withdrawal symptoms you have after stopping opioids. These symptoms can include tremor, sweating, and muscle aches. In this phase, you’ll typically take Bunavail in your doctor’s office or clinic.

Day 1: You’ll take your first dose when you start having withdrawal symptoms (at least 6 hours after stopping opioids). For this dose, your doctor will usually give you a Bunavail film containing 2.1 mg buprenorphine/0.3 mg naloxone. Your doctor will typically monitor you for 2 hours after you take this dose. If your withdrawal symptoms aren’t managed with this dose, your doctor will likely give you another Bunavail film containing 2.1 mg buprenorphine/0.3 mg naloxone.

Day 2: If you haven’t had withdrawal symptoms, your doctor will likely give you one Bunavail film containing 4.2 mg buprenorphine/0.7 mg naloxone. If you have had withdrawal symptoms, your doctor will likely give you two Bunavail films containing 4.2 mg buprenorphine/0.7 mg naloxone. You’ll take these at the same time, by placing one film inside each cheek.

Day 3 and beyond: If you’ve had withdrawal symptoms, your doctor may increase your dose by 2.1 mg buprenorphine/0.3 mg naloxone each day. Your doctor may do this until your withdrawal symptoms are managed for at least 2 days in a row.

Maintenance phase

This is the ongoing phase of treatment. It aims to help manage your opioid withdrawal symptoms and cravings. This can help keep you from using opioids again.

The recommended dosage for the maintenance phase is two Bunavail films containing 4.2 mg buprenorphine/0.7 mg naloxone (a total of 8.4 mg buprenorphine/1.4 mg naloxone) taken once daily. However, your doctor will prescribe the dosage that’s right for you.

In this phase, your doctor might allow you to take Bunavail at home.

About taking Bunavail

Below you’ll find information about key dosage issues.

• When to take: After your first day of treatment, you should take Bunavail once per day. Taking the medication around the same time of day helps keep a steady level of the drug in your body. This helps Bunavail work effectively.
• If you miss a dose: If you miss a dose, take it as soon as possible. But if it’s nearly time for your next dose, skip the missed dose. Take your next dose as usual when it’s due. Do not take two doses together to make up for a missed dose. This could cause an overdose.
• Taking Bunavail with food: After placing Bunavail inside your cheek, you should avoid eating or drinking until the film has dissolved.
• Splitting, swallowing, or chewing Bunavail: You should not split, cut, tear, chew, or swallow Bunavail film, as this can make it less effective.
• Length of use: Bunavail is typically used as a long-term treatment. If you and your doctor determine that Bunavail is safe and effective for you, you may take it long term.
• Length of time to work: Bunavail starts working to relieve opioid withdrawal symptoms and cravings as soon as the film starts to dissolve. It usually takes about 15 to 30 minutes for the film to dissolve completely.

Overdose

Using more than the recommended dosage of Bunavail can lead to serious side effects. Do not use more Bunavail than your doctor recommends.

If a child takes Bunavail, deliberately or by accident,they may have severe breathing problems that can lead to death. Be sure to store Bunavail in a place where children can’t access it.

Your doctor will likely recommend keeping naloxone (Narcan) nasal spray on hand while you’re taking Bunavail. Narcan is a medication that can be used in an emergency to help treat an opioid overdose. Your doctor can prescribe Narcan, or you can get it from a pharmacy. For more information, talk with your doctor or pharmacist.

Overdose symptoms

Symptoms of an overdose can include:

• blurred vision
• slurred speech
• confusion
• coordination problems
• slowed reflexes
• dizziness or fainting
• pinpoint pupils (unusually small pupils in normal lighting conditions)
• respiratory depression (breathing that’s slow, shallow, or stops altogether)
• severe sleepiness
• unresponsiveness

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away. You or another person should also administer Narcan if it’s available.

If a child takes Bunavail, call 911 or your local emergency number, or take them to the nearest emergency room right away. You should also administer Narcan if it’s available.

Bunavail side effects

Bunavail can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Bunavail. These lists do not include all possible side effects.

For more information about the possible side effects of Bunavail, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Bunavail, you can do so through MedWatch.

Mild side effects

Below is a partial list of mild side effects of Bunavail. To learn about other mild side effects, talk with your doctor or pharmacist, or view Bunavail’s prescribing information.

Mild side effects of Bunavail can include:

• headache
• nausea and vomiting
• constipation*
• insomnia
• increased sweating
• pain
• swelling of the legs, feet, arms, or hands

Most of these side effects may go away within a few days to a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.

* For more information about this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Bunavail aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• reduced ability to safely drive or operate machines, which may include symptoms such as:
  • sleepiness
  • dizziness
  • slowed reaction times
  • confusion
• respiratory depression, which may include symptoms such as:
  • slow, weak, or shallow breathing
  • breathing that stops completely
• adrenal insufficiency, which may include symptoms such as:
  • weakness or fatigue
  • nausea and vomiting
  • low blood pressure
  • dizziness
• liver problems, which may include symptoms such as:
  • nausea and vomiting
  • abdominal pain
  • dark urine
  • jaundice (yellowing of the skin or eyes)
• dental problems, which may include symptoms such as:
  • toothache
  • teeth or fillings becoming loose or falling out
• drop in blood pressure that causes dizziness*
• opioid withdrawal symptoms if Bunavail is started too soon, stopped suddenly, or injected†
• physical dependence on Bunavail†
• risk of misuse†

* For more information about this side effect, see “Side effect details” just below.
† For more information about this side effect, see the section below called “Bunavail withdrawal and dependence”.

Side effect details

Drop in blood pressure that causes dizziness

Bunavail can sometimes cause orthostatic hypotension, which is a drop in blood pressure that happens upon standing up. It can make you feel dizzy or lightheaded and can even cause fainting.

It’s not known how often orthostatic hypotension occurs with Bunavail. It’s more likely to happen with higher doses.

To help prevent orthostatic hypotension, you should avoid getting up quickly while taking Bunavail. For example, if you’ve been lying down, sit up for a moment before standing up.

If you feel dizzy or lightheaded, sit or lie down until this passes. Then get up more slowly.

If you often have episodes of orthostatic hypotension while taking Bunavail, talk with your doctor. They may recommend reducing your dose.

Constipation

You may have constipation while taking Bunavail. In clinical studies, this was one of the more common side effects reported with the drug.

If you have bothersome constipation while taking Bunavail, talk with your doctor or pharmacist. They may recommend taking a laxative medication to relieve your symptoms.

ALLERGIC REACTION

For some people, Bunavail can cause an allergic reaction.

In general, symptoms of allergic reaction can be mild or serious. You can learn more about possible symptoms in this article.

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Bunavail, your doctor may recommend taking a different medication instead.

Bunavail withdrawal and dependence

It’s possible to become physically dependent on Bunavail. With physical dependence, your body relies on a drug to function as usual. This means you may have withdrawal symptoms if you suddenly stop taking the drug.

Withdrawal symptoms you may have if you suddenly stop taking Bunavail are usually milder than those you may have after stopping opioids. They can include:

• muscle aches
• shaking
• sweating
• feeling hot or cold
• goose bumps
• runny nose
• watery eyes
• diarrhea
• vomiting

You should not suddenly stop taking Bunavail without talking with your doctor first. If you and your doctor determine you should stop Bunavail treatment, your doctor will likely reduce your dosage gradually first. This can help prevent withdrawal symptoms.

If you have questions about Bunavail dependence and withdrawal, talk with your doctor or pharmacist.

Opioid withdrawal symptoms if Bunavail is started too soon or injected

Bunavail can cause opioid withdrawal symptoms if you start taking it before the effects of opioids have worn off. You should not take your first dose of Bunavail until you start having withdrawal symptoms (at least 6 hours after stopping opioids).

Bunavail can also cause opioid withdrawal symptoms if you’re dependent on opioids and you misuse Bunavail by injecting it. (Bunavail is a partial opioid agonist. It is a Schedule III controlled substance that has a risk of misuse. Misuse refers to taking the drug differently than how your doctor prescribes it.)

If you misuse Bunavail by dissolving the film and injecting the medication, Bunavail will block the effect of any opioids you have in your system. This will immediately cause severe opioid withdrawal symptoms. You should only take Bunavail by placing the film inside your cheek at least 6 hours after stopping other opioids.

If you have questions about starting Bunavail or misuse of Bunavail, talk with your doctor or pharmacist.

Alternative drugs

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Bunavail, talk with your doctor. They can tell you about other medications that may work well for you.

The following drugs are alternatives to Bunavail:

• other opioid agonists, such as:
  • methadone (Methadose)
  • buprenorphine sublingual tablets
  • buprenorphine injection (Sublocade, Brixadi)
  • buprenorphine/naloxone sublingual tablets or films (Suboxone, Zubsolv)
• opioid antagonists, such as:
  • naltrexone injection (Vivitrol)
  • naltrexone tablets

Bunavail vs. Zubsolv

Bunavail is discontinued and doctors no longer prescribe it. You may wonder how Bunavail compares with other medications that are prescribed for similar uses. Here we look at how Bunavail compares to Zubsolv.

Bunavail and Zubsolv contain the same active ingredients: buprenorphine and naloxone. They’re both approved to treat opioid use disorder. They can cause similar side effects.

These drugs come in different strengths and are taken in different ways. Bunavail comes as a film that you place inside your cheek, where it dissolves. Zubsolv comes as a tablet that dissolves under your tongue.

Your doctor may prescribe Zubsolv instead of Bunavail, but they’ll likely prescribe a different dosage. To learn more about how these drugs compare, talk with your doctor or pharmacist.

Bunavail uses

The Food and Drug Administration (FDA) approves prescription drugs such as Bunavail to treat certain conditions.

Bunavail for opioid use disorder

Bunavail is FDA-approved to treat opioid use disorder (sometimes called opioid dependence) in adults. It’s approved for this use as part of a treatment program that may include psychotherapy, counseling, and social support.

With opioid use disorder, you’re unable to stop using opioid drugs, even when these drugs have negative effects on your health, relationships, or work. With this disorder, you depend on opioids to function as usual, both physically and mentally. As a result, if you stop using opioids, you may have withdrawal symptoms like shaking, sweating, muscle aches, and anxiety. You may also have cravings for opioids.

Bunavail helps manage withdrawal symptoms and cravings you may have after stopping opioids. This can help keep you from using these drugs again.

Bunavail and children

Bunavail is not FDA-approved for use in children under 18 years old.

Bunavail interactions

Bunavail can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Before taking Bunavail, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

Interactions with medications, foods, and supplements

Below is a list of medications, supplements, and foods that can interact with Bunavail. This list does not contain all drugs that may interact with Bunavail. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Alcohol interaction

It’s not safe to consume alcohol while taking Bunavail. If you have questions about the safety of drinking alcohol while taking Bunavail, talk with your doctor or pharmacist.

Bunavail cost and coupons

As with all medications, the cost of Bunavail can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Financial and insurance assistance: If you need financial support to pay for Bunavail, or if you need help understanding your insurance coverage, help is available.

To learn more about saving money on prescriptions, check out this article.

Generic version: Bunavail is discontinued, but it is available in a generic form called buprenorphine/naloxone. A generic drug is an exact copy of the active ingredient in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs. To find out how the cost of buprenorphine/naloxone compares to the cost of Bunavail, talk with your doctor or pharmacist.

To learn more about saving money on prescriptions, check out this article.

How Bunavail works

Bunavail is approved to treat opioid use disorder. With this disorder, your body depends on opioid drugs to function as usual. You’ll start treatment with Bunavail when you have withdrawal symptoms after stopping other opioids.

Bunavail contains buprenorphine, which is a partial opioid agonist. It also contains naloxone, which is an opioid antagonist (blocker).

The buprenorphine in Bunavail works by attaching to the same receptors (attachment sites) as opioids. It produces similar physical effects to the other opioid, but without producing the same pleasurable or high feelings. This helps manage withdrawal symptoms and opioid cravings you have after stopping other opioids. It can help keep you from using opioids again.

The naloxone in Bunavail is included to prevent misuse of the medication. (Misuse refers to taking the drug in a way other than how your doctor prescribes it.) Naloxone isn’t absorbed into your body and doesn’t have an effect when you take the Bunavail film as intended, by placing it inside your cheek. However, if you misuse Bunavail (e.g., by dissolving the film and injecting the medication), the naloxone will block the effect of any opioids in your system. This will immediately cause severe opioid withdrawal symptoms.

Things to consider when taking Bunavail

If you can become pregnant, consider the following information about pregnancy, fertility, birth control, and breastfeeding.

Bunavail and pregnancy

There are risks associated with taking Bunavail during pregnancy. But there are also risks with having untreated opioid use disorder while pregnant. (Bunavail is used to treat opioid use disorder.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about potential treatments for opioid use disorder during pregnancy. Together, you can consider the risks and benefits of your treatment options and decide whether or not you should take Bunavail during pregnancy.

Bunavail and fertility

Long-term use of Bunavail (and long-term use of opioids) can reduce fertility in males and females. It’s not known whether fertility improves after stopping long-term opioid use.

If you’re concerned about the effects of Bunavail or opioids on your fertility, talk with your doctor.

Note: Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Bunavail and birth control

There are risks to taking Bunavail during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Bunavail.

Bunavail and breastfeeding

In general, Bunavail is considered safe to take while breastfeeding. However, you should still ask your doctor whether they feel it’s safe for you.

If you do breastfeed while taking Bunavail, you should watch your child closely. Talk with your doctor if the child is sleepier than usual, has trouble feeding, or is not gaining weight. But call 911 right away if the child has slow or shallow breathing, you can’t wake them, or they become limp.

Common questions about Bunavail

Here are answers to some frequently asked questions about Bunavail.

Will I have withdrawal symptoms when I stop using Bunavail?

You might if you suddenly stop using Bunavail.

While taking Bunavail, your body may depend on the drug to function as usual. So if you suddenly stop using it, you may have withdrawal symptoms.

However, withdrawal symptoms can usually be avoided if your Bunavail dose is slowly reduced before stopping treatment.

If you want to stop using Bunavail, you should talk with your doctor first. If together you decide that you’re ready to stop Bunavail, your doctor can explain how to safely taper (gradually reduce) your dose of the drug.

For more information about Bunavail withdrawal symptoms, see the section above called “Bunavail withdrawal and dependence.”

Can I eat, drink, or smoke cigarettes while I have a Bunavail film inside my cheek?

You should not eat or drink while you have a Bunavail film stuck inside your cheek. Doing so could make the film come off before it’s fully dissolved. This could stop the full dose of Bunavail from being absorbed into your system, which could make it less effective.

Smoking while you have a Bunavail film inside your cheek is unlikely to affect the medication. (However, if you want to quit smoking and would like help with this, talk with your doctor.)

If I’m using Suboxone, can I switch to Bunavail?

Bunavail has been discontinued by the manufacturer and is no longer available. However, Bunavail and Suboxone both contain buprenorphine and naloxone, and generic forms of these drugs are available.

If you’re using Suboxone, it’s likely possible to switch to generic buprenorphine/naloxone. However, your doctor may prescribe a different dose depending on the form you switch to.

If you’re interested in switching from Suboxone to a different form of buprenorphine/naloxone, talk with your doctor.