Dosing

Though pre-induction guidelines are slightly different for patients dependent on long- vs. short-acting opioids, the induction and dosing process is the same. Give the first dose when the patient is in mild to moderate opioid withdrawal on the COWS scale.

Induction Day 1

Related Resources: 
Description: 
This PDF Document contains the Clinical Opioid Withdrawal Scale (COWS), a common instrument used to assess a patient's opioid withdrawal severity.
Source: 
California Society of Addiction Medicine (CSAM)
field_vote: 
Patient Handouts: 

After determining that a patient is appropriate for buprenorphine treatment, the clinician should do the following before starting induction:

Product How Supplied (Buprenorphine / Naloxone mg) Induction Target Dose Instructions for Use
Suboxone®

Sublingual Film

Reckitt Benckiser
View ReferencesHide References
Actavis Elizabeth LLC. Buprenorphine HCl and naloxone HCl prescribing information. Actavis. 2013. Available at: https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=110562 Accessed on: 2014-10-07.
BioDelivery Sciences International . Bunavail prescribing information . BDSI. 2014. Available at: http://www.bdsi.com/siteres.aspx?resid=5a738443-a797-41cd-a39a-a8deb2a4a585 Accessed on: 2014-10-06.
Orexo US Inc. Zubsolv prescribing information. Zubsolv. 2013. Available at: https://www.zubsolv.com/wp-content/uploads/2015/01/ZubsolvFullPrescribingInformation.pdf Accessed on: 2015-04-02.
Reckitt Benckiser Pharmaceuticals Inc. Suboxone Prescribing Information. Reckitt Benckiser Pharmaceuticals. 2014. Available at: http://www.suboxone.com/content/pdfs/prescribing-information.pdf Accessed on: 2014-10-09.
Related Resources: 
Description: 
This provides prescribing information for Suboxone sublingual film and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Reckitt Benckiser Pharmaceuticals
field_vote: 
Description: 
Prescribing information for Zubsolv sublingual tablets
Source: 
Zubsolv
field_vote: 
Description: 
This provides prescribing information for Bunavail buccal film and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
BDSI
field_vote: 
Description: 
This provides prescribing information for Buprenorphine sublingual tablets and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Roxane Laboratories
field_vote: 
Description: 
This provides prescribing information for Buprenorphine HCl and naloxone HCl sublingual tablets and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Actavis Elizabeth LLC
field_vote: 

 

This information is not current

 

Standardized dosing protocols are available, but induction should be conducted through careful observation and the dosing should be adjusted accordingly

Related Resources: 

Patient Handout: Buprenorphine or Naloxone Combination-What Does It Mean for You?

Description: 
This patient handout explains buprenorphine, its makeup, and how it works to treat withdrawal.

Buprenorphine/Naloxone Combination Film or Tablets -- What do They Mean for You?


Your physician has prescribed buprenorphine/naloxone combination tablets (generic or Zubsolv®*) or film (Suboxone®) for you. There are a few things you should know before you begin taking it.


What is buprenorphine?
Buprenorphine is a type of drug called an opioid, similar to heroin, methadone or Oxycontin®. Taking buprenorphine will prevent you from going into withdrawal and should stop you from craving other opioids.


What is naloxone?
Naloxone counteracts opioids --including buprenorphine. If you take naloxone while you have an opioid in your system, or if you are dependent on opioids and find that you go into withdrawal without them, naloxone can trigger withdrawal.


That doesn't make sense --why would my provider prescribe a drug which will send me into withdrawal?
Your buprenorphine/naloxone combination medication will not send you into withdrawal --provided you take them as your provider prescribes!


If you dissolve the tablets or film under your tongue, or if you accidentally swallow one, the naloxone will not affect you --your body breaks the naloxone down too quickly for it to take effect! However, if you inject a combination tablet or film, the naloxone will take effect. You will probably not feel anything from the buprenorphine, and you could go into withdrawal.

 

 

 

How Taken Buprenorphine Naloxone What you feel
Under the tongue (as directed)
  • Works properly
  • Broken down by the body
  • No withdrawal; reduced craving
Swallowed (accidental)
  • Broken down by body
  • Medicine will not work; you could go into withdrawal or feel cravings
Injected (abuse)
  • Blocked by naloxone
  • Blocks effects of opioids
  • You could go into withdrawal very quickly

 

 

 

*We are using brand names since there is a difference in the product that is not reflected in the generic name. We are not advocating one brand or the other.

Description: 
Prescribing information for Zubsolv sublingual tablets
Source: 
Zubsolv
field_vote: 
Description: 
Find the links to each buprenorphine formulation's medication guide here
Source: 
FDA
field_vote: 
Patient Handouts: 
Description: 
Guidelines from Boston Medical Center designed for patient maintained on buprenorphine underdoing invasive procedures.
Source: 
Colleen LaBelle, Boston Medical Center
field_vote: 
Description: 
This provides prescribing information for Suboxone sublingual film and includes information on indications, dosing, contraindications, adverse reactions, drug interactions and use in specific populations.
Source: 
Reckitt Benckiser Pharmaceuticals
field_vote: 
Description: 
This newsletter article from NAABT.org lists and describes 15 ways patients can save money on buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
field_vote: 
Patient Handouts: 

Day 2+

Description: 
Induction for Non-Physically Dependent Patients

This flow chart depicts clinical guidelines for Day 2 of induction for non-physically dependent patients. Guidelines are provided for whether agonist side effects emerge, whether side effects occur, and establishing a daily dose.

field_vote: 
Resource Type: 
Physician stage in practice: 

Pages

Subscribe to Dosing