Known brand names include Suboxone.
A film that dissolves under the tongue or inside the cheek, combining buprenorphine, a partial opioid agonist, with naloxone, an opioid blocker. It treats opioid dependence as part of a full treatment plan with counseling and support, and it is a Schedule III controlled substance.
Buprenorphine attaches to mu opioid receptors, which full opioids such as heroin and morphine also switch on, but it switches them on only partway. That partial effect is enough to ease withdrawal, and its opioid effects level off at higher doses instead of continuing to climb. It also blocks a second opioid receptor, the kappa receptor. Naloxone, the other ingredient, has no meaningful effect when the film dissolves in the mouth, but it brings on withdrawal if the medicine is injected by someone dependent on opioids, which discourages that misuse.
Its effects come near their peak in under 2 hours and last long enough for one dose a day, since the body takes 24 to 42 hours to clear half of the buprenorphine. If the first dose is taken while a full opioid is still working, its partial effect can set off sudden withdrawal, so treatment starts only once clear withdrawal signs appear. Because it is still an opioid, it can slow breathing dangerously, especially with alcohol, benzodiazepines, or other sedating drugs. Long-term use makes the body dependent on it, so stopping suddenly causes withdrawal, which is usually milder and slower to start than with full opioids.
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Buprenorphine and naloxone treats opioid dependence, an addiction to opioid drugs such as heroin or prescription painkillers. It prevents the withdrawal symptoms that start when a person stops using those drugs. The aim is to keep the person in treatment with withdrawal under control, because relapse after stopping treatment puts them at risk of overdose.
It is used within a full treatment plan that also includes counseling and psychosocial support. Treatment usually starts with doses taken under supervision, and later doses are taken at home as the person becomes stable. Its safety and effectiveness have not been shown in children, and it is not meant to treat pain. It is also not used for withdrawal in newborns, because the naloxone in it blocks opioids.
Headache, nausea, vomiting, constipation, sweating, trouble sleeping, pain, and swelling in the legs are common, and the film often numbs, reddens, or hurts the mouth and tongue. The label treats slowed or stopped breathing as the most serious risk, often with injection misuse or with alcohol, benzodiazepines, or other sedatives, and accidental exposure can cause fatal breathing problems in a child. It also warns about liver injury, severe allergic reactions, tooth decay and tooth loss, withdrawal after stopping suddenly, and withdrawal in newborns after use in pregnancy. Dizziness on standing, low adrenal hormone levels, and misuse or addiction are other listed risks.
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