What is Bunavail?

Bunavail is a brand-name prescription medication used to treat opioid dependence, which is now called opioid use disorder by healthcare professionals.

Opioids include prescription pain relievers such as codeine, hydrocodone and oxycodone, and illegal drugs such as heroin. Opioid drugs are sometimes called opiates or narcotics.

Bunavail is approved for use only in adults. Use in children can be dangerous and possibly fatal.

Bunavail is a small rectangular film that you stick inside your cheek, where it dissolves. Bunavail contains the drugs buprenorphine and naloxone.

Buprenorphine belongs to a class of drugs called partial opioid agonists. Naloxone belongs to a class of drugs called opioid antagonists. A class of drugs is a group of medications that have similar properties and work in a similar way.

Bunavail films come in 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

Bunavail helps control the cravings and withdrawal symptoms you may get when you stop using opioids. Bunavail is used as one part of a complete treatment program. Your program may also include counseling or psychotherapy and social support (such as help with housing or employment if needed).

Effectiveness

Buprenorphine/naloxone combination drugs like Bunavail have been shown to be effective for treating opioid dependence. Several studies have found that these drugs help prevent people from going back to misusing other opioids. They also help keep people with opioid dependence in a treatment program. The American Society of Addiction Medicine recommends using buprenorphine-naloxone products to treat opioid dependence.

In one study, people who were currently stable on other sublingual forms of buprenorphine/naloxone were switched to Bunavail. (A sublingual drug is a medication you take under your tongue.) The study showed that Bunavail was as safe and effective at controlling opioid dependence as other forms of buprenorphine/naloxone.

For more details on Bunavail's effectiveness, see the "Bunavail for opioid dependence" section below.

Is Bunavail a controlled substance?

Yes, Bunavail is a Schedule III controlled substance. This is a type of drug that has a high chance of misuse and a high risk of becoming dependent on using it.

Because of these risks, there are special rules about how Bunavail can be prescribed and dispensed. It is illegal for you to sell Bunavail or give it to someone else.

Doctors must have special training and receive certification from the U.S. government to prescribe Bunavail for people with opioid dependence.

Bunavail is banned in competitive sports. Talk with your doctor about your options if you're in a competitive sport and wish to take a medication to treat opioid dependence.

Bunavail generic

Bunavail is only available as a brand-name medication.

Bunavail contains two active ingredients: buprenorphine and naloxone. This form of buprenorphine/naloxone film is not currently available as a generic.

Other buprenorphine and naloxone films are available as generics, but these come in different strengths than Bunavail. You also take them in a slightly different way (under your tongue or between your gum and your cheek). This means they may not be exactly the same as Bunavail.

Other brand-name drugs containing buprenorphine and naloxone include Suboxone films and Zubsolv tablets.

If you switch to Bunavail from another buprenorphine/naloxone product (brand-name or generic), your dosage may not be the same. Talk with your doctor if you're interested in switching to a different drug.

Bunavail vs. Suboxone

You may wonder how Bunavail compares to other medications that are prescribed for similar uses. Here we look at how Bunavail and Suboxone are alike and different.

Uses

Bunavail and Suboxone are both brand-name medications that are FDA-approved to treat opioid dependence. They are both used as part of a complete treatment program. Your program may also include counseling or psychotherapy and social support (such as help with housing or employment if needed).

Bunavail and Suboxone are only approved for use in adults.

Bunavail and Suboxone both contain buprenorphine and naloxone.

Drug forms and administration

Bunavail comes as a film that you stick on the inside of your cheek, where it dissolves. The medication is absorbed directly into your blood through your cheek lining. The films have a special layer on the back. This helps the drug to be absorbed through your cheek and reduces the amount that is swallowed.

Bunavail films come in 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

Suboxone also comes as a film. You take it by letting the film dissolve under your tongue or inside your cheek. The medication is absorbed into your blood through your mouth lining in these areas. More of the medication is absorbed by using the films inside your cheek rather than under your tongue.

Suboxone films come in four strengths:

  • 2 mg buprenorphine/0.5 mg naloxone
  • 4 mg buprenorphine/1 mg naloxone
  • 8 mg buprenorphine/2 mg naloxone
  • 12 mg buprenorphine/3 mg naloxone

Side effects and risks

Bunavail and Suboxone both contain buprenorphine and naloxone. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Suboxone or with both drugs (when taken individually).

  • Can occur with Suboxone:
    • redness in the mouth
    • swollen or painful tongue
  • Can occur with both Bunavail and Suboxone:
    • opioid withdrawal symptoms, such as muscle aches, sweating, and shaking
    • constipation
    • headache
    • nausea
    • vomiting
    • insomnia (trouble sleeping)
    • sweating

Serious side effects

Examples of serious side effects that can occur with both Bunavail and Suboxone (when taken individually) include:

  • feeling sleepy
  • drop in blood pressure that causes dizziness, especially when getting up from sitting or lying down
  • breathing problems that can lead to coma and death
  • physical dependence on and misuse of Bunavail or Suboxone
  • severe opioid withdrawal symptoms if Bunavail or Suboxone is injected
  • severe allergic reaction
  • liver damage
  • problems with your adrenal glands (glands above your kidneys that produce certain hormones)

Effectiveness

The only condition both Bunavail and Suboxone are used to treat is opioid dependence.

The American Society of Addiction Medicine recommends buprenorphine/naloxone (including both these brand-name drugs) as a treatment for opioid dependence. Both drugs contain the same active ingredients, so they're considered equally effective.

Talk with your doctor about whether Bunavail or Suboxone is a better fit for you.

Costs

Bunavail and Suboxone are both brand-name drugs. There is currently no generic form of Bunavail. Generic forms of Suboxone are available. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Bunavail generally costs more than Suboxone. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Bunavail dosage

The Bunavail dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of opioid dependence
  • the stage of treatment you're in
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they'll adjust it over time to reach the amount that's right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Bunavail is a rectangular film that you stick to the inside of your cheek. The medication is absorbed into your bloodstream through your cheek lining.

Bunavail films come in 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 dependence

You should take Bunavail according to your doctor's instructions. There are two phases of treatment, and your dosage will depend on which phase you're in.

Induction phase

Treatment with Bunavail starts in the induction phase. This will usually take place in your doctor's office or a clinic.

You'll be given Bunavail to control the withdrawal symptoms you may get after you stop taking other opioids. (Although Bunavail is used to treat opioid dependence, it does contain an opioid.) These withdrawal symptoms may include muscle aches, sweating, and shaking.

Day 1

  • Don't take your first Bunavail dose until at least 6 hours after you last used other opioids and symptoms of opioid withdrawal have begun.
  • You'll probably start with a dose of 2.1 mg buprenorphine/0.3 mg naloxone.
  • Your doctor should monitor you for 2 hours. If your withdrawal symptoms aren't controlled, you'll likely be given another dose of 2.1 mg buprenorphine/0.3 mg naloxone.

Day 2

  • If you haven't had withdrawal symptoms, you'll likely be given a film containing a dose of 4.2 mg buprenorphine/0.7 mg naloxone. (This is the same as the total dose you may have had on day 1.)
  • If you have had withdrawal symptoms, you'll probably be given two films containing 4.2 mg buprenorphine/0.7 mg naloxone (a total dose of 8.4 mg buprenorphine/1.4 mg naloxone).

Day 3 and after

  • If your withdrawal symptoms aren't controlled, your dose will probably be increased by 2.1 mg buprenorphine/0.3 mg naloxone each day. Your doctor will likely increase your dose until your withdrawal symptoms are controlled for at least 2 days in a row.

Maintenance phase

In this phase, you keep taking the lowest dose that controls your withdrawal symptoms and cravings. You'll take Bunavail once a day at this dose. This will make it easier for you to avoid using other opioids.

The recommended dosage for the maintenance phase is 8.4 mg buprenorphine/1.4 mg naloxone daily. Your doctor will determine the dosage that's right for you. They may allow you to take Bunavail at home in this phase if they thinks that's appropriate for you.

What if I miss a dose?

If you forget to take a Bunavail dose at your usual time, take it as soon as you remember. However, if it's nearly time for your next dose, just skip the missed dose. Take your next dose as usual when you normally would. Never take a double dose to make up for a missed dose.

To help make sure you don't miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Treatment for opioid dependence is usually long term. If you and your doctor determine that Bunavail is safe and effective for you, you'll likely take it long term as part of your treatment program. You and your doctor will decide together if and when you might be ready to stop using Bunavail.

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 on the possible side effects of Bunavail, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

More common side effects

The more common side effects of Bunavail can include:

  • constipation
  • headache
  • nausea
  • vomiting
  • insomnia (trouble sleeping)
  • sweating
  • opioid withdrawal symptoms, such as muscle aches, sweating, and shaking (see the "Bunavail withdrawal" section below)

Most of these side effects may go away within a few days or a couple of weeks. If they're more severe or don't go away, talk with your doctor or pharmacist.

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 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Call 911 if a child takes Bunavail, either accidentally or deliberately. Bunavail can cause severe breathing problems in children that are a life-threatening medical emergency.

Serious side effects, explained in more detail below under "Side effect details," can include:

  • feeling sleepy
  • drop in blood pressure that causes dizziness, especially when getting up from sitting or lying down
  • breathing problems and coma
  • physical dependence on and misuse of Bunavail
  • severe opioid withdrawal symptoms if Bunavail is injected (see the "Bunavail withdrawal" section below for more information)
  • severe allergic reaction
  • liver damage
  • problems with your adrenal glands (glands above your kidneys that produce certain hormones)

Side effect details

You may wonder how often certain side effects occur with this drug. Here's some detail on several of the side effects this drug may cause.

Sleepiness

Sleepiness may occur when taking Bunavail. People taking it could also have slower reaction times. These are common side effects, especially in the first few weeks of taking Bunavail or when your dose is increased. These side effects are also possible if you take other medications that can cause sleepiness.

Do not drive, operate machinery, or do other potentially dangerous activities such as riding a bike or climbing a ladder if Bunavail makes you feel sleepy.

Drop in blood pressure that causes dizziness

Opioids such as Bunavail can sometimes cause your blood pressure to fall. This can make you feel dizzy, especially when you get up from sitting or lying down. If you feel dizzy, lie down until this passes.

Breathing problems and coma

Taking Bunavail could result in breathing problems and coma. Buprenorphine, an ingredient in Bunavail, can cause respiratory depression (slowed breathing). It can also cause central nervous system (CNS) depression, which means slowed brain activity. CNS depression can lead to delirium and coma. Respiratory depression can cause your breathing to stop completely.

Respiratory depression and CNS depression can both be fatal. Call 911 or get emergency medical help if you have symptoms of respiratory depression or CNS depression while taking Bunavail. These symptoms can include:

  • slow, shallow breathing
  • extreme sleepiness
  • confusion
  • slurred speech
  • problems with coordination
  • dizziness or fainting

If you take more Bunavail than prescribed, you have a higher risk of getting certain side effects. These include breathing problems, loss of consciousness (not being able to respond to sound or touch), and death.

If you drink alcohol or take certain other drugs with Bunavail, you have a higher risk of breathing problems, loss of consciousness, and death. Some examples of drugs you shouldn't take with Bunavail are listed below.

Do not take any of these with Bunavail, unless they've been prescribed by a doctor who knows you're taking Bunavail:

  • benzodiazepines, such as lorazepam (Ativan), diazepam (Valium), or alprazolam (Xanax)
  • sleeping pills, such as zolpidem (Ambien) or (zaleplon) Sonata
  • other tranquilizers or sedatives
  • opioids, such as codeine, hydromorphone (Vicodin), or oxycodone (Oxycontin, Oxaydo)
  • muscle relaxants
  • certain antidepressants
  • antihistamines that cause drowsiness, such as hydroxyzine (Atarax), diphenhydramine (Benadryl), or chlorpheniramine (Chlor-Trimeton)

Physical dependence and misuse

Your body can become physically dependent on Bunavail. This is because it contains an opioid, even though it's used to treat opioid dependence. The opioid in Bunavail could lead to you craving higher or more frequent doses. It could also lead to you misusing Bunavail or trying to get other opioids.

Bunavail is prescribed as part of a complete treatment program. This means you'll get additional support to help keep you from misusing opioids.

If you're physically dependent on Bunavail and you suddenly stop taking it, this can cause withdrawal symptoms. These can include muscle aches, sweating, and shaking. If and when it's time to stop treatment with Bunavail, you'll do this slowly to avoid withdrawal symptoms. See the "Bunavail withdrawal" section below for more details.

Bunavail is a drug that can be misused, so you should keep it in a safe place at all times to prevent theft.

Talk with your doctor if you're worried about becoming dependent on Bunavail.

Severe allergic reaction

As with most drugs, some people can have a serious allergic reaction, such as anaphylaxis, after taking Bunavail. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing
  • skin rash, hives, or itching

Call your doctor right away if you have a severe allergic reaction to Bunavail. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Liver damage

Taking opioids like Bunavail can lead to liver problems, including hepatitis (liver inflammation). Tell your doctor if you develop symptoms of liver problems, which can include:

  • jaundice (yellowing of your skin or the whites of your eyes)
  • dark urine
  • pale stools
  • abdominal (belly) pain
  • nausea
  • loss of appetite

Your doctor will take blood tests regularly to check your liver function. These tests are called liver function tests. If the results show damage to your liver, you may need to stop taking Bunavail.

Adrenal gland problems

Using opioids such as Bunavail may cause adrenal insufficiency (when your adrenal glands stop making enough of a hormone called cortisol). Your adrenal glands sit on top of your kidneys and produce certain hormones. Adrenal problems are more likely when you use opioids for longer than a month.

Talk with your doctor if you get symptoms of adrenal problems, which can include:

If you have problems with your adrenal glands, you may need to take steroid medication. You may also need to stop taking Bunavail.

Constipation

You may experience constipation while taking Bunavail. It's a common side effect of buprenorphine/naloxone drugs like Bunavail.

One 12-week study suggested that constipation may occur less often with Bunavail than with sublingual forms of buprenorphine/naloxone. A sublingual drug is a tablet, film, or spray that you take under your tongue.

In the study, researchers looked at 186 people who were taking sublingual buprenorphine/naloxone. These people were switched to an equivalent dose of Bunavail for 12 weeks. At the start of the study, 40.9% of these people reported constipation. After 12 weeks of taking Bunavail, the percentage of people reporting constipation had dropped to 12.9%.

When you take Bunavail by placing the film in your cheek, you swallow less buprenorphine than when taking sublingual buprenorphine/naloxone. The special layer on the back of Bunavail films reduces the amount of buprenorphine that dissolves in your mouth and can be swallowed. This could explain these results. However, the study was not blinded, which means the investigators and the participants knew what treatment they were being given. This could have affected the results.

Headache

You may experience headaches while taking Bunavail. This is a common side effect in people taking buprenorphine/naloxone drugs. In clinical studies, about 30% of people taking these drugs experienced a headache.

If you get headaches, ask your doctor or pharmacist to recommend a pain reliever you could take. It's usually fine to take acetaminophen or ibuprofen with Bunavail.

Bunavail withdrawal

There are three ways you could get withdrawal symptoms with Bunavail.

Starting Bunavail treatment too soon

If you start treatment with Bunavail before the effects of other opioids have worn off, it could cause withdrawal symptoms, such as muscle aches, sweating, and shaking.

You shouldn't start taking Bunavail until you've stopped using other opioids and are experiencing moderate withdrawal symptoms. Bunavail will help to control these withdrawal symptoms.

Suddenly stopping Bunavail

Once you've started taking Bunavail, your body can become physically dependent on it. This means you could get withdrawal symptoms if you suddenly stop taking it. These symptoms are usually mild and may include:

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

If you and your doctor decide that you should stop taking Bunavail, you'll do this slowly to avoid getting withdrawal symptoms.

Injecting Bunavail

Do not try to inject Bunavail. If injected, the naloxone in Bunavail will block the effects of any opioids you already have in your system.

If you're physically dependent on opioids and you inject Bunavail, you will likely have immediate severe opioid withdrawal symptoms. These could include:

  • pain
  • cramps
  • vomiting
  • diarrhea
  • anxiety
  • sleep problems
  • cravings for opioids

When you take Bunavail by putting the film inside your cheek, not much naloxone is absorbed into your body. This prevents you from having the same severe reaction as when you inject Bunavail.

Alternatives to Bunavail

Other drugs are available that can treat opioid dependence. 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.

Examples of other drugs used to treat opioid dependence include:

  • Other opioid agonists, such as:
    • methadone (Dolophine)
    • buprenorphine sublingual tablets (Subutex)
    • buprenorphine implant (Probuphine)
    • buprenorphine injection (Sublocade)
    • buprenorphine/naloxone sublingual tablets or films (Suboxone, Zubsolv)
  • Opioid antagonists, such as:
    • naltrexone injection (Vivitrol)
    • naltrexone implant
    • naltrexone tablets

Bunavail vs. Zubsolv

You may wonder how Bunavail compares to other medications that are prescribed for similar uses. Here we look at how Bunavail and Zubsolv are alike and different.

Uses

Bunavail and Zubsolv are brand-name medications that are FDA-approved to treat opioid dependence. They are both used as part of a complete treatment program. Your program may also include counseling or psychotherapy and social support (such as help with housing or employment if needed).

Bunavail and Zubsolv both contain buprenorphine and naloxone.

Drug forms and administration

Bunavail comes as a film that you stick on the inside of your cheek, where it dissolves. The medication is absorbed directly into your blood through your cheek lining. The film has a special layer on the back that helps the drug be absorbed through your cheek and reduces the amount that is swallowed.

Bunavail films come in 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

Zubsolv comes as a sublingual tablet that dissolves under your tongue. The medication is absorbed directly into your blood from under your tongue.

Zubsolv sublingual tablets come in six strengths:

  • 0.7 mg buprenorphine/0.18 mg naloxone
  • 1.4 mg buprenorphine/0.36 mg naloxone
  • 2.9 mg buprenorphine/0.71 mg naloxone
  • 5.7 mg buprenorphine/1.4 mg naloxone
  • 8.6 mg buprenorphine/2.1 mg naloxone
  • 11.4 mg buprenorphine/2.9 mg naloxone

Side effects and risks

Bunavail and Zubsolv both contain buprenorphine and naloxone. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

Examples of more common side effects that can occur with Bunavail or Zubsolv (when taken individually) include:

  • opioid withdrawal symptoms, such as muscle aches, sweating, and shaking
  • constipation
  • headache
  • nausea
  • vomiting
  • insomnia (trouble sleeping)
  • sweating

Serious side effects

Examples of serious side effects that can occur with both Bunavail and Zubsolv (when taken individually) include:

  • feeling sleepy
  • drop in blood pressure that causes dizziness, particularly when getting up from sitting or lying down
  • breathing problems and coma
  • physical dependence on and misuse of Bunavail or Zubsolv
  • severe opioid withdrawal symptoms if Bunavail or Zubsolv is injected
  • severe allergic reaction
  • liver damage
  • problems with your adrenal glands (glands above your kidneys that produce certain hormones)

Effectiveness

The only condition both Bunavail and Zubsolv are used to treat is opioid dependence. These medications contain the same active ingredients and are considered equally effective. They are both included in guidelines from the American Society of Addiction Medicine as a treatment for opioid use disorder.

Talk with your doctor about whether Bunavail or Zubsolv is a better fit for you.

Costs

Bunavail and Zubsolv are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Zubsolv is generally more expensive than Bunavail. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Bunavail for opioid dependence

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

Bunavail is FDA-approved to treat opioid dependence in adults. Opioid dependence is now called opioid use disorder (OUD) by healthcare professionals.

With OUD, your body is physically dependent on opioid drugs. You may get cravings or withdrawal symptoms (such as muscle aches, sweating, and shaking) when you stop taking them.

Opioid drugs include prescription pain relievers such as codeine, oxycodone (Oxycontin, Oxaydo), and hydrocodone (Vicodin), and illegal drugs such as heroin. Opioids are sometimes called opiates or narcotics.

Bunavail, which contains naloxone and the opioid buprenorphine, helps relieve the physical withdrawal symptoms you may get when you stop using other opioids. It also helps reduce cravings for these drugs.

Bunavail is used to manage the initial withdrawal from opioids, which is called the induction phase of treatment. It's also used in the long-term management of opioid dependence, which is called the maintenance phase.

Bunavail should only be used as an induction treatment in people who are using short-acting opioids such as heroin, codeine, or oxycodone. People using long-acting opioids such as methadone should use a medication that only contains buprenorphine as their induction treatment.

Effectiveness

Bunavail is recommended for treating opioid dependence in guidelines from the American Society of Addiction Medicine.

Several studies have shown that treatment with buprenorphine/naloxone combination drugs, including Bunavail, helps people with opioid dependence stop misusing opioids. It also helps keep people with opioid dependence in a treatment program.

In one study, people who were currently stable on other sublingual forms of buprenorphine/naloxone were switched to Bunavail. (A sublingual drug is a medication that you take under your tongue.) The people were assessed for opioid withdrawal symptoms using the Clinical Opiate Withdrawal Scale (COWS). They were assessed both before they received a dose of Bunavail and 3 hours after receiving the dose. The COWS score ranges from zero (no symptoms) to 25 (highest symptoms).

Before the people took Bunavail, their average COWS score was 3.3. Three hours after they took the medication, their average score was less than or equal to 0.54. This shows a reduction in opioid withdrawal symptoms.

The study showed that Bunavail was as safe and effective at controlling opioid dependence as other forms of buprenorphine/naloxone.

Bunavail use with other treatments

If you're prescribed Bunavail, it will be just one part of a complete treatment program for opioid dependence. Your program may also include counseling or other forms of emotional or behavioral therapy. This may include individual therapy, group counseling sessions, or family therapy.

As part of your treatment, you may participate in support groups or practice self-help. If necessary, you might also get support with issues such as housing or employment.

These treatments can help you learn ways to avoid or cope with situations that might lead you to use opioids again.

Bunavail and alcohol

Do not drink alcohol while you're taking Bunavail. Drinking alcohol increases your risk of overdose and serious side effects, which can include:

  • respiratory depression (slowed breathing)
  • severe sleepiness
  • loss of consciousness (not being able to respond to sound or touch)
  • coma
  • death

Talk with your doctor if you're concerned about avoiding alcohol while taking Bunavail.

Bunavail interactions

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

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Bunavail and other medications

Below is a list of medications that can interact with Bunavail. This list does not contain all drugs that may interact with Bunavail.

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.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Bunavail and benzodiazepines (drugs for anxiety or insomnia)

In general, you shouldn't take benzodiazepines with Bunavail. The only exception is if your doctor knows you're taking Bunavail and prescribes benzodiazepines to you.

Taking benzodiazepines with Bunavail can increase the risk of serious side effects, such as breathing problems, severe sleepiness, loss of consciousness (not being able to respond to touch or sound), coma, and death.

Examples of benzodiazepines include:

  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • lorazepam (Ativan)

Bunavail and sleeping pills

In general, you shouldn't use sleeping pills while you're taking Bunavail. The only exception is if your doctor knows you're taking Bunavail and prescribes sleeping pills to you.

Taking sleeping pills with Bunavail can increase the risk of serious side effects, such as breathing problems, severe sleepiness, loss of consciousness, coma, and death.

Examples of sleeping pills include:

  • eszopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien)

Bunavail and other opioids

Unless prescribed by a doctor who knows you're taking Bunavail, don't use other opioids while taking Bunavail. (Although Bunavail is used to treat opioid dependence, it does contain an opioid.)

Opioid pain relievers will be less effective if you take them with Bunavail. Also, taking other opioids with Bunavail can increase the risk of serious side effects, such as breathing problems, severe sleepiness, loss of consciousness, coma, and death.

Examples of opioids that increase the risk of serious side effects if taken with Bunavail include:

  • codeine
  • dihydrocodeine
  • heroin
  • hydrocodone (Vicodin)
  • methadone (Dolophine)
  • morphine (Kadian)
  • oxycodone (Oxycontin, Oxaydo)

Taking certain opioids with Bunavail can increase the risk of getting a rare but serious side effect called serotonin syndrome. These drugs are:

  • fentanyl (Abstral, Fentora, and others)
  • tramadol (Ultram, Conzip)

Serotonin syndrome is caused by high levels of a chemical called serotonin in your brain. Symptoms can include diarrhea, nausea, shaking, fast heartbeat, confusion, anxiety, and hallucinations (seeing or hearing things that aren't really there).

Bunavail and certain antidepressants

Taking Bunavail with antidepressants that make you sleepy can increase the risk of serious side effects. These include breathing problems and severe sleepiness.

Some antidepressants increase serotonin levels in your brain. Bunavail also increases serotonin in your brain. Serotonin is a chemical that sends messages between nerve cells.

High levels of serotonin raise your risk of a rare but serious side effect called serotonin syndrome. Symptoms can include diarrhea, nausea, shaking, fast heartbeat, confusion, anxiety, and hallucinations.

Examples of antidepressants that can increase the risk of serious side effects if taken with Bunavail include:

  • selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil, Pexeva, Brisdelle), and sertraline (Zoloft)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
  • tricyclic antidepressants such as amitriptyline, desipramine (Norpramin), and imipramine (Tofranil)
  • monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine (Parnate)
  • mirtazapine (Remeron)
  • trazodone

If you take one of these drugs, talk to your doctor before starting Bunavail. They may recommend a different treatment.

Bunavail and certain antihistamines

Taking Bunavail with antihistamines that make you sleepy could cause excessive sleepiness and breathing problems. Don't take these with Bunavail unless prescribed by a doctor who knows you're taking Bunavail.

Examples of these antihistamines include:

  • chlorpheniramine (Chlor-Trimeton)
  • diphenhydramine (Benadryl)
  • hydroxyzine (Atarax)

Bunavail and certain muscle relaxants

Taking certain muscle relaxants with Bunavail can increase the risk of serious breathing problems. Don't take these with Bunavail unless prescribed by a doctor who knows you're taking Bunavail.

Examples of these muscle relaxants include:

  • baclofen
  • tizanidine (Zanaflex)

Bunavail and certain drugs for fungal infections

Taking certain antifungal drugs with Bunavail can increase the level of buprenorphine in your body. This can raise your risk of side effects, such as sleepiness, breathing problems, constipation, nausea, and dizziness.

Examples of antifungals that increase buprenorphine levels include:

  • itraconazole (Sporanox)
  • ketoconazole
  • posaconazole (Noxafil)
  • voriconazole (Vfend)

If you need to take one of these antifungals, your doctor may lower your Bunavail dose temporarily. See a doctor right away if you get side effects such as slow, shallow breathing, severe sleepiness, confusion, slurred speech, or problems with coordination.

Bunavail and certain antibiotics

Taking certain antibiotics (drugs for bacterial infections) with Bunavail can increase the level of buprenorphine in your body. This can raise your risk of getting side effects, such as sleepiness, breathing problems, constipation, nausea, and dizziness.

Examples of antibiotics that increase buprenorphine levels include:

  • clarithromycin (Biaxin)
  • erythromycin (Ery-Ped, Ery-Tab, Erythrocin)
  • telithromycin (Ketek)

If you need to take one of these antibiotics, your doctor may lower your Bunavail dose temporarily. Call your doctor right away if you get side effects such as slow, shallow breathing, severe sleepiness, confusion, slurred speech, or problems with coordination.

Taking the antibiotic linezolid (Zyvox) with Bunavail can increase the risk of a rare side effect called serotonin syndrome. Symptoms can include diarrhea, nausea, shaking, fast heartbeat, confusion, anxiety, and hallucinations. See a doctor right away if you get any of these side effects.

Bunavail and certain HIV drugs

Taking certain HIV medications with Bunavail can increase the level of buprenorphine in your body. This can increase your risk of getting side effects, such as sleepiness, breathing problems, constipation, nausea, and dizziness.

Examples of drugs for HIV that increase buprenorphine levels include:

  • atazanavir (Reyataz)
  • cobicistat (Tybost)
  • darunavir (Prezista)
  • fosamprenavir (Lexiva)
  • indinavir (Crixivan)
  • ritonavir (Norvir)
  • saquinavir (Invirase)

If you take one of these drugs with Bunavail, see a doctor right away if you get side effects such as slow, shallow breathing, severe sleepiness, confusion, slurred speech, or problems with coordination.

Bunavail and certain drugs for tuberculosis

Taking certain tuberculosis treatments with Bunavail can lower the level of buprenorphine in your body. This could cause withdrawal symptoms. Your doctor may temporarily increase your dose of Bunavail if you take one of these tuberculosis drugs. Examples include:

  • rifabutin (Mycobutin)
  • rifampin (Rifadin)
  • rifapentine (Priftin)

Bunavail and certain drugs for seizures

Taking certain seizure medications with Bunavail can lower the level of buprenorphine in your body. If you start taking one of these when you're in the maintenance phase of treatment with Bunavail, it could cause withdrawal symptoms.

Examples of these seizure medications include:

  • carbamazepine (Carbatrol, Equetro, Tegretol)
  • fosphenytoin (Cerebyx)
  • oxcarbazepine (Trileptal)
  • phenobarbital
  • phenytoin (Dilantin, Phenytek)
  • primidone (Mysoline)

Bunavail and certain drugs for migraine

Triptan medications treat migraine headaches by increasing the level of serotonin in your brain. Serotonin is a chemical that sends messages between nerve cells. Bunavail can also increase serotonin levels.

Taking a triptan medication with Bunavail can raise your risk of a rare but serious side effect caused by high levels of serotonin. This is called serotonin syndrome. Symptoms can include diarrhea, nausea, shaking, fast heartbeat, confusion, anxiety, and hallucinations. See a doctor right away if you get these symptoms.

Examples of triptan medications include:

  • almotriptan (Axert)
  • eletriptan (Relpax)
  • frovatriptan (Frova)
  • naratriptan (Amerge)
  • rizatriptan (Maxalt)
  • sumatriptan (Imitrex)
  • zolmitriptan (Zomig)

Bunavail and anticholinergic drugs

Taking anticholinergic drugs with Bunavail can increase your risk of constipation or difficulty urinating. Examples of anticholinergic drugs include:

  • drugs for overactive bladder or urinary incontinence (loss of bladder control), such as fesoterodine (Toviaz) and oxybutynin (Gelnique, Ditropan XL, Oxytrol)
  • certain drugs for Parkinson's disease, such as trihexyphenidyl
  • certain drugs for chronic obstructive pulmonary disease (COPD) such as tiotropium (Spiriva) and glycopyrrolate (Seebri)

Bunavail and herbs and supplements

Below is a list of herbs and supplements that can interact with Bunavail. Talk with your doctor before using any of these products while taking Bunavail.

Bunavail and St John's wort

Taking St. John's wort (also called Hypericum perforatum) with Bunavail can lower the level of buprenorphine in your body. This could make Bunavail less effective or cause withdrawal symptoms.

Taking St. John's wort with Bunavail can also raise your risk of a rare but serious side effect called serotonin syndrome. Serotonin syndrome is caused by high levels of serotonin, a chemical that sends messages between nerve cells. Symptoms can include diarrhea, nausea, shaking, fast heartbeat, confusion, anxiety, and hallucinations. See a doctor right away if you get these symptoms.

Bunavail and herbs and supplements that cause drowsiness

Taking Bunavail with herbs or supplements that cause drowsiness (sleepiness) might make you excessively sleepy. Examples of these supplements include:

  • chamomile
  • kava
  • melatonin
  • valerian

Bunavail cost

As with all medications, the cost of Bunavail can vary. To find current prices for Bunavail in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. 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.

BioDelivery Sciences International Inc., the manufacturer of Bunavail, offers help for people with insurance coverage for prescription drugs and for those who plan to pay without insurance. For more information and to find out if you're eligible for support, visit the program website.

How to take Bunavail

You should take Bunavail according to your doctor or healthcare provider's instructions.

You stick Bunavail films to the inside of your cheek. The drug is absorbed into your body through your cheek lining as the film dissolves. The Bunavail website has step-by-step instructions and a video explaining how to take Bunavail.

When to take

It doesn't matter what time of day you take Bunavail, but always take it exactly as instructed by your doctor. There are two phases of treatment, and your dosage will depend on which phase you're in.

See the "Bunavail dosage" section for more information.

Induction phase

Treatment with Bunavail starts in the induction phase. This will usually take place in your doctor's office or a clinic. You'll take your first dose at least 6 hours after you last used other opioids.

You'll be given Bunavail once you start to get withdrawal symptoms (such as muscle aches, sweating, and shaking). Your doctor should monitor you for 2 hours. If your withdrawal symptoms aren't well controlled, you'll likely get a second dose.

On the second day and following days, your doctor will adjust your dosage until your withdrawal symptoms are controlled for at least 2 days in a row. After that, you'll move into the maintenance phase.

Maintenance phase

In this phase, you'll keep taking the lowest dose that controls your withdrawal symptoms and cravings. You'll take Bunavail once a day at this dose. This will make it easier for you to avoid using other opioids. You can take Bunavail at home in this phase if your doctor thinks that's appropriate for you.

How Bunavail works

With opioid dependence, you have problems with craving and misusing opioid drugs. You may also be physically dependent on these drugs.

Opioid drugs are those with a chemical structure that's similar to opium. They include prescription pain relievers such as codeine, oxycodone (Oxycontin, Oxaydo), and hydrocodone (Vicodin), and illegal drugs such as heroin.

Opioids work by activating special areas in your brain called opioid receptors. This causes pleasurable feelings, known as a high. It also relieves pain. These effects can lead you to crave these drugs.

When opioids activate the opioid receptors, it can cause you to become physically dependent on the drug. This means you may get withdrawal symptoms (such as muscle aches, sweating, and shaking) when you stop using them.

What Bunavail does

Bunavail contains two active ingredients: buprenorphine and naloxone.

Buprenorphine is an opioid drug. However, it's a slightly different type of opioid, called a partial opioid agonist. It acts on your opioid receptors, but it doesn't activate them as much as full opioid agonists, such as heroin or morphine.

Buprenorphine doesn't produce the same kind of pleasurable feelings that other opioids like heroin or morphine do. However, it has enough effect to stop you from craving other opioids. It can help relieve the withdrawal symptoms you may get when you stop using other opioids.

Taking buprenorphine long term helps keep your cravings and withdrawal symptoms under control. This can help keep you from using other opioids while you're going through your treatment program. Your doctor can help you create a plan (which may include emotional and behavioral therapies) to slowly wean off Bunavail when you're ready.

Naloxone is included in Bunavail films to help prevent people from misusing them. Naloxone is an opioid antagonist, which means it blocks opioid receptors. If you're physically dependent on opioids and you try to inject Bunavail, the naloxone would block the effects of any opioids in your body. This would give you instant withdrawal symptoms. (See the "Bunavail withdrawal" section above to learn more.)

When you take Bunavail by placing the film inside your cheek, very little naloxone is absorbed into your body. This prevents you from having the same severe reaction as when you inject Bunavail.

How long does it take to work?

As the Bunavail film dissolves, buprenorphine is absorbed directly into your blood through your cheek lining. The film starts to dissolve as soon as you place it inside your cheek. How long it takes to dissolve varies among people. The buprenorphine starts to relieve withdrawal symptoms and cravings as soon as it gets into your bloodstream.

Bunavail and pregnancy

There hasn't been enough research to know if Bunavail or the drugs it contains (buprenorphine and naloxone) are safe to take during pregnancy. Limited information from clinical studies suggests that buprenorphine doesn't seem to cause birth defects. There isn't enough information available to know if naloxone can affect a developing fetus.

Call your doctor right away if you become pregnant while taking Bunavail.

If you do use Bunavail while pregnant, your baby could have opioid withdrawal symptoms at birth. This condition is called neonatal withdrawal syndrome. Symptoms can include:

  • irritability (getting easily upset)
  • high-pitched crying
  • crying much more than usual
  • shaking
  • trouble sleeping
  • diarrhea
  • vomiting
  • not gaining weight

Current guidelines recommend that pregnant women with opioid dependence receive treatment with methadone. Buprenorphine on its own is another option that might be better for pregnant women than buprenorphine/naloxone combinations like Bunavail.

If you are pregnant and dependent on opioids, talk with your doctor about getting treatment. Untreated opioid dependence is linked with premature birth, low birth weight, and fetal death.

Bunavail and birth control

It's not known if Bunavail is safe to take during pregnancy. If you or your sexual partner could become pregnant, talk with your doctor about your birth control needs while you're using Bunavail.

Bunavail and breastfeeding

Bunavail contains two drugs: buprenorphine and naloxone. Clinical studies show that buprenorphine passes into breast milk in small amounts. Naloxone may also pass into breast milk, but it's not absorbed by a nursing child.

Bunavail is generally thought to be safe to take while breastfeeding, but talk with your doctor about this. If you decide to breastfeed your child while taking Bunavail, it's important to keep a close eye on them.

  • Tell your doctor if your child seems more sleepy than usual, has trouble breastfeeding, or isn't gaining weight.
  • Call 911 if your child has trouble breathing (slow and shallow breaths), if you can't wake them, or if 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?

Not necessarily. Bunavail contains an opioid, so you can get withdrawal symptoms if you stop taking it suddenly. These could include muscle aches, sweating, and shaking. However, if your dosage is lowered gradually over time, you may be able to prevent most withdrawal symptoms.

If and when you and your doctor decide it's time to stop treatment with Bunavail, talk with them about the best way to avoid withdrawal symptoms.

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

You shouldn't eat or drink while you have a film inside your cheek. This could make the film come off before it's fully dissolved.

Smoking while you have a film inside your cheek will likely not cause problems with Bunavail. (If you would like resources to help you quit smoking, talk with your doctor.)

Can I cut a Bunavail film in half?

No, do not cut or tear Bunavail films.

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

Yes. Bunavail and Suboxone contain the same drugs, so you can switch if your doctor thinks it's a good idea for you.

If you switch to Bunavail from Suboxone, it may seem that you've been prescribed a lower dose. However, this is not the case. The medication gets absorbed into your blood more efficiently from Bunavail films than from Suboxone films. This means that lower doses of Bunavail will have the same effect as higher doses of Suboxone.

If you're interested in switching to Bunavail, talk with your doctor to learn more.

Bunavail precautions

Before taking Bunavail, talk with your doctor about your health history. Bunavail may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Lung disease. If you have certain conditions that affect your breathing, you may not be able to take Bunavail because you're more at risk for severe breathing problems. These conditions include chronic obstructive pulmonary disease (COPD), asthma, and sleep apnea.
  • Underactive adrenal glands (Addison's disease or adrenal insufficiency). If your adrenal glands (glands above your kidneys that produce certain hormones) don't produce enough hormones, you may not be able to take Bunavail. This is because Bunavail can cause problems with your adrenal glands, which could be dangerous if you have underactive glands.
  • Liver disease, including hepatitis. You may not be able to take Bunavail if you have moderate or severe liver problems. This is because Bunavail can cause liver problems or worsen any liver problems you already have.
  • Recent head injury or brain problem. Bunavail can increase the pressure of the fluid in your brain and spinal cord. If you have a brain injury or other brain problem, this can be dangerous. Bunavail can also make you sleepy and your pupils smaller, which makes it more difficult for doctors to monitor you. You may not be able to take Bunavail. Talk with your doctor about other possible treatments.
  • Gallbladder problems. You may not be able to take Bunavail if you have gallbladder problems. This is because Bunavail could make gallbladder problems worse.
  • Pregnancy. If you take Bunavail during pregnancy, your baby may be born with opioid withdrawal symptoms. For more information, please see the "Bunavail and pregnancy" section above.
  • Breastfeeding. Breastfeeding while taking Bunavail is most likely safe, but talk to your doctor if you plan to breastfeed while taking it. For more information, see the "Bunavail and breastfeeding" section above.

Note: For more information about the potential negative effects of Bunavail, see the "Bunavail side effects" section above.

Bunavail overdose

Using more than the recommended dosage of Bunavail can lead to serious and life-threatening side effects.

Overdose symptoms

Symptoms of a Bunavail overdose can include:

  • respiratory depression (slow, shallow breathing)
  • extreme sleepiness or sedation
  • confusion
  • blurred vision
  • slurred speech
  • problems with coordination
  • slowed reflexes
  • dizziness or fainting
  • pinpoint pupils (abnormally small pupils in normal lighting conditions)

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 the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Bunavail expiration, storage, and disposal

When you get Bunavail from the pharmacy, the pharmacist will add an expiration date to the label on the box. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee the medication will be effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store it.

Bunavail film should be stored at room temperature, around 68°F to 77°F (20°C to 25°C). Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Keep your Bunavail films in a safe place. This means where children cannot see or reach them, and where they are not at risk of theft.

Disposal

If you no longer need to take Bunavail and have leftover medication, it's important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Professional information for Bunavail

The following information is provided for clinicians and other healthcare professionals.

Indications

Bunavail is approved to treat opioid dependence and is suitable for induction and maintenance treatment. It should be used alongside counseling and psychosocial support as part of a comprehensive treatment program.

Mechanism of action

Bunavail films contain buprenorphine, a partial opioid agonist at mu receptors, and naloxone, an opioid antagonist at mu receptors.

Buprenorphine is absorbed through the buccal mucosa from Bunavail films. The films have a backing layer that reduces dissolution of the drug in the mouth and minimizes the amount swallowed. Buprenorphine reduces withdrawal symptoms and drug cravings after stopping full opioid agonists.

Naloxone has no clinically significant effect when taken buccally. However, if Bunavail is injected, it will cause opioid withdrawal in people dependent on full opioid agonists.

Pharmacokinetics and metabolism

Bunavail films have a higher bioavailability than Suboxone sublingual tablets (which are no longer available). The backing layer prevents the buprenorphine from dissolving in the mouth where it can be swallowed, and directs more of the drug through the buccal mucosa. The buprenorphine available from one Bunavail 4.2 mg/0.7 mg buccal film corresponds to that available from one Suboxone 8 mg/2 mg sublingual tablet.

The buccal absorption of buprenorphine from Bunavail varies widely between people, so doses must be individualized based on response. Naloxone is poorly absorbed buccally.

Buprenorphine is primarily metabolized by hepatic CYP3A4 enzymes. It is excreted mainly in the feces, with a small amount in the urine. Naloxone is also metabolized hepatically.

Buprenorphine has a mean half-life of 16.4 to 27.5 hours. Naloxone has a mean half-life of 1.9 to 2.4 hours.

The metabolism of buprenorphine and naloxone is reduced in moderate and severe hepatic impairment.

Contraindications

Bunavail is contraindicated in people with known hypersensitivity to buprenorphine or naloxone.

Misuse and dependence

Bunavail is a Schedule III controlled drug that has potential for misuse and diversion. The patient and their social/home situation should be fully assessed before prescribing Bunavail for use at home. Multiple refills should not be issued.

Long-term use of Bunavail can lead to physical dependence and withdrawal symptoms upon stopping treatment.

Storage

Bunavail must be stored securely at room temperature, around 68°F to 77°F (20°C to 25°C) and not higher than 86°F (30°C).

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.