Buprenorphine is a prescription medication. It’s approved by the Food and Drug Administration (FDA) to treat opioid dependence in adults. Opioid dependence is also called opioid use disorder (OUD), which is how it’s referred to throughout this article.
With OUD, your body and mind depend on opioid drugs. This dependence may lead to cravings for opioids, including pain relievers such as hydrocodone, oxycodone, morphine, and fentanyl. Opioids also include some illegal drugs, such as heroin.
Drugs such as buprenorphine are used to treat OUD when you stop using opioids. Buprenorphine tablets may help reduce cravings and prevent withdrawal symptoms as part of a complete treatment plan for OUD.
Here are the basics on buprenorphine:
- Active ingredient: buprenorphine
- Drug class: partial opioid agonist
- Drug form: sublingual tablet, which is dissolved under the tongue, to treat OUD*
- Available as a brand-name drug: not in tablet form†
Read on for more information on buprenorphine and its use in treating opioid use disorder. You can also refer to this article for a comprehensive look at buprenorphine and its other uses.
* Buprenorphine is also approved to manage pain in certain situations. For this purpose, the drug comes in patch and injection form. To learn more, talk with your doctor or pharmacist.
† In tablet form, buprenorphine was once available as the brand-name medication Subutex, but it’s been discontinued. In subcutaneous injection form, buprenorphine is available as the brand-name drug Sublocade, which is approved to treat moderate to severe OUD. For more information, talk with your doctor or pharmacist.
Buprenorphine is a generic drug, which is an exact copy of the active drug in a brand-name medication. Buprenorphine tablets are based on the brand-name medication Subutex, which is no longer available. A generic is considered as effective and safe as the brand-name drug. Generics tend be less expensive than brand-name drugs.
In subcutaneous injection form, buprenorphine is available only as the brand-name drug Sublocade, which is approved to treat moderate to severe OUD. Sublocade is a type of buprenorphine liquid solution that slowly releases the drug into your body over time. It isn’t available as a generic.
You can learn more about generic drugs and brand-name drugs here.
The use of buprenorphine tablets for opioid use disorder (OUD)* may cause side effects that are mild or serious. Side effects may also be called adverse effects.
The lists below include some of the main side effects that have been reported with buprenorphine tablet use. For information on other potential side effects of the drug, talk with your doctor or pharmacist. You can also read the prescribing information for buprenorphine tablets.
Note: After the Food and Drug Administration (FDA) approves a medication, it tracks side effects of the drug. If you develop a side effect while taking buprenorphine and would like to inform the FDA, visit MedWatch.
* In tablet form, buprenorphine is approved to treat only OUD. Buprenorphine is also available in other forms that are approved to treat other conditions. It’s important to note that side effects from buprenorphine may differ depending on the condition the drug is used to treat and the form used.
Mild side effects
Mild side effects from buprenorphine tablets can include:
- nausea or vomiting
- a sensation of numbness or burning in your mouth
- insomnia (difficulty falling asleep, staying asleep, or both)
- sweating more than usual
These side effects of buprenorphine tablets may be temporary, lasting a few days or weeks. But if they last for a longer time, or if they bother you or become severe, it’s important to talk with your doctor or pharmacist.
Serious side effects
Serious side effects can occur during treatment with buprenorphine tablets, although they aren’t common. These serious side effects can include:
- orthostatic hypotension (a sudden drop in blood pressure when standing up, which can cause fainting)
- respiratory depression (slow, shallow breathing)*
- central nervous system depression (slowed brain activity)*
- physical dependence (when your body gets used to having a drug)
- adrenal gland problems, such as adrenal gland insufficiency (low levels of certain hormones made by the adrenal gland)
- liver problems, including hepatitis (inflammation in your liver)
- allergic reaction
Call your doctor right away if you develop serious side effects while using buprenorphine tablets. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.
* In some cases, this side effect may lead to coma or, very rarely, death.
The Food and Drug Administration (FDA) has approved buprenorphine tablets to treat opioid use disorder (OUD) in adults. The drug isn’t approved to treat pain, but it may be prescribed off-label for this purpose, according to a review of studies. (Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.)
In addition, other forms of buprenorphine may be used to treat pain. These include:
- solution given as an intramuscular injection (Buprenex)
- buccal film (Belbuca)
- transdermal patch (Butrans)
For treating pain, these three forms of buprenorphine are approved for use in people who require around-the-clock opioid treatment to manage pain. They must have previously tried nonopioid pain relievers or other treatments that didn’t work.
If you have questions about using buprenorphine for pain, talk with your doctor to learn more.
Below are answers to some questions about using buprenorphine for opioid use disorder.
What’s the difference between buprenorphine and methadone?
Buprenorphine tablets and methadone are approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD) in adults. Also, buprenorphine tablets may be prescribed off-label* to treat pain, while methadone tablets are FDA-approved to treat pain. Both buprenorphine and methadone are classified as opioid medications.
In addition, both drugs can cause some common mild and serious side effects, including:
- nausea and vomiting
- respiratory depression (slow, shallow breathing)
- central nervous system depression (slowed brain activity)
- orthostatic hypotension (a sudden drop in blood pressure when standing up, which can cause fainting )
- physical dependence (when your body gets used to having a drug)
However, buprenorphine tablets and methadone have some differences as well. Rarely, methadone can increase the risk of seizures if you have a seizure disorder. This isn’t a known side effect of buprenorphine tablets. Also, to treat OUD, buprenorphine tablets are typically taken once per day. Methadone, on the other hand, is typically taken two or three times per day.
If you have additional questions about how buprenorphine and methadone compare, talk with your doctor or pharmacist.
* Off-label drug use means using a drug for a purpose other than what it’s been approved for by the FDA.
If I stop using buprenorphine, could I have withdrawal symptoms?
Yes, it’s possible to have withdrawal symptoms if you stop using buprenorphine tablets.
This is because your body can become physically dependent on the drug. (With physical dependence, your body gets used to having a drug.) So it’s possible to have mild withdrawal symptoms after stopping treatment with buprenorphine tablets.
Withdrawal symptoms can include:
- body aches
- belly cramps
- rapid heart rate
- feeling hot or cold
Talk with your doctor about what you should do if you have withdrawal symptoms. They may recommend treatments that could ease the symptoms. And keep in mind that you shouldn’t stop taking buprenorphine unless your doctor specifically tells you to do so.
Could taking too much buprenorphine lead to overdose?
Yes, taking too high a dose of buprenorphine tablets can lead to overdose. A buprenorphine overdose can, in some cases, be fatal.
Symptoms of a buprenorphine overdose can include:
- pinpoint pupils
- low blood pressure
- sedation (feeling drowsy or tired)
- respiratory depression
To avoid taking too much buprenorphine, you should use this medication only as your doctor prescribes. You shouldn’t take more or less buprenorphine unless your doctor specifically changes your dose.
If you believe you or someone else has taken too much buprenorphine, call 911 or your local emergency number, or go to the closest emergency room or hospital right away.
Buprenorphine tablets are approved to treat opioid use disorder (OUD) in adults. The tablets are sublingual, meaning they’re dissolved under the tongue. They’re available in two strengths: 2 milligrams (mg) and 8 mg.
For this use, 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.
Buprenorphine treatment for OUD is typically given in two stages: induction and maintenance treatment. Here’s some information on both stages.
For treating OUD, buprenorphine tablets are typically used for induction treatment, which may also be called induction therapy. This is when you take the drug for up to a few days after your last opioid dose to help manage withdrawal symptoms.
On the first day of induction treatment, your doctor may start by giving you a low dose of buprenorphine tablets. If your withdrawal symptoms persist, your doctor may increase the dose in increments of 2 mg to 4 mg. They’ll determine your induction dose based on your opioid use history. You’ll likely take the drug once per day.
How soon you take your first buprenorphine tablet dose depends on the opioid you’ve been taking. If you’ve been using:
- short-acting opioids, such as heroin, it must be at least 4 hours since your last dose before you can take your first buprenorphine tablet dose
- long-acting opioids, such as methadone, it must be at least 24 hours since your last dose before you can take your first buprenorphine tablet dose
The next stage of buprenorphine care for OUD is known as maintenance treatment. Using buprenorphine tablets for OUD maintenance isn’t advised. Instead, your doctor will typically switch you to a product that has both buprenorphine and the drug naloxone, such as Suboxone. (Naloxone helps protect against misuse. This means that due to the addition of naloxone, withdrawal symptoms would be less severe with Suboxone than with buprenorphine alone.)
Some people have side effects to naloxone or otherwise can’t tolerate it. In general, a dosage adjustment of just buprenorphine may be effective for OUD maintenance in this group. The standard maintenance dosage range is 4 mg to 24 mg per day.
Note: In addition to treating OUD, buprenorphine has other drug forms with other uses. Keep in mind that the drug’s dosage may differ with these other uses. To learn more, talk with your doctor.
With opioid use disorder (OUD), your body and mind depend on opioid drugs. This dependence may lead to cravings for opioids, including pain relievers such as hydrocodone, oxycodone, morphine, and fentanyl. Opioids also include some illegal drugs, such as heroin.
Symptoms of opioid use disorder
According to the American Psychiatric Association, symptoms of OUD can include:
- having a craving or strong desire to use opioids
- continued opioid use despite repeated relationship problems
- reducing or giving up activities due to opioid use
- problems fulfilling obligations at home, school, or work due to opioid use
- opioid tolerance (needing to take more of the drug to have the same effects)
- experiencing withdrawal symptoms
Who buprenorphine is prescribed for
Buprenorphine tablets are approved to treat OUD in adults as part of a complete treatment plan. The plan may include counseling and support.
Drugs such as buprenorphine tablets are used to treat OUD when you stop using opioids. Buprenorphine tablets may help reduce cravings and prevent withdrawal symptoms.
Opioids are powerful drugs often used to treat pain. Examples of opioids include prescription pain relievers, such as oxycodone and hydrocodone, and illegal drugs such as heroin.
Opioids work in areas in your brain called mu opioid receptors. When the drugs act there, they can cause strong pain-relieving effects. The action of the opioids can also lead to a “high” feeling that can make you crave opioids. Repeated opioid use can lead to dependence, which can cause withdrawal symptoms if you stop taking opioids.
The way buprenorphine works
Buprenorphine tablets are commonly used in treatment programs for opioid use disorder (OUD). The drug is what’s known as a partial opioid agonist. It acts on your mu opioid receptors like other opioids, but it doesn’t stimulate them as strongly.
In this way, buprenorphine tablets help you stop craving opioids without making you feel high. The drug also helps prevent withdrawal symptoms that you may have when you stop using other opioids.
Guidelines from the American Society of Addiction Medicine recommend buprenorphine as a treatment option for treating opioid use disorder (OUD) in adults.
Studies looked at adults with OUD who took buprenorphine tablets or placebo tablets. (A placebo is a treatment without an active drug.)
Compared with the placebo group, the buprenorphine group was more likely to remain in treatment for OUD. The buprenorphine group was also more likely to reduce or avoid the use of opioids while in the study.
How to use
Buprenorphine tablets are what are known as sublingual tablets. Sublingual means the tablets should be placed under your tongue, where they’ll dissolve. You shouldn’t eat or drink until the tablet dissolves completely. It’s also important not to chew, crush, or swallow the tablets.
If your dose requires more than one buprenorphine tablet, you should place two tablets under your tongue at a time and repeat as required. You may also place all the tablets under your tongue to dissolve at once, if you can do so comfortably.
How often to use
You should take buprenorphine tablets according to your doctor’s instructions. Buprenorphine tablets are typically taken once daily.
Buprenorphine is a Schedule III controlled drug, which means it has potential for misuse. The term “misuse” means using a drug differently than how the doctor prescribed it.
Misuse of buprenorphine tablets by self-injection has led to severe infection and withdrawal symptoms, such as vomiting, anxiety, and pain. Misuse in this manner has also led to coma, and in some cases, death. Do not use buprenorphine tablets other than exactly how your doctor prescribes.
In addition, taking buprenorphine tablets may cause you to be physically dependent on the drug. So if your doctor prescribes buprenorphine tablets, you should be monitored for misuse, addictive behaviors, and diversion during your treatment. (“Diversion” refers to giving or selling prescription drugs to other people).
If you have any concerns about buprenorphine tablets and misuse, talk with your doctor.
Before you use buprenorphine tablets, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.
If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before using buprenorphine tablets:
- if you have a history of lung problems, trouble breathing, or a curve in your spine that affects your breathing
- if you have liver, kidney, or gallbladder problems
- if you have a head injury or brain problem
- if you have an enlarged prostate gland
- if you have difficulty urinating
- if you have adrenal gland problems, Addison’s disease, or hypothyroidism (low levels of thyroid hormones)
- if you have a history of alcohol use disorder
- if you have any other medical condition
- if you’re pregnant or thinking of becoming pregnant
- if you’re breastfeeding or thinking of breastfeeding
- if you’ve had an allergic reaction to buprenorphine or any of its ingredients
How much buprenorphine tablets cost is based on several factors. These can include your prescribed treatment regimen, the insurance plan you have, the pharmacy you use, and your location.
Financial assistance may help lower the cost of buprenorphine. To see what resources are available, visit the websites NeedyMeds and Medicine Assistance Tool. They may also be able to help you find more affordable healthcare and educational information.
Buprenorphine is a generic drug. In tablet form, buprenorphine was once available as the brand-name medication Subutex, but it’s been discontinued. In injection form, buprenorphine is available as the brand-name drug Sublocade. Generics are often less expensive than brand-name medications. For information on Sublocade, talk with your doctor or pharmacist.
Now that you’ve learned about buprenorphine tablets for opioid use disorder, you may still have some questions. Talk with your doctor or pharmacist, who can advise you on whether buprenorphine tablets might be right for you.
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.