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Buprenorphine Naloxone Brand Names
BUNAVAIL | CASSIPA | Suboxone | Zubsolv
What is Buprenorphine Naloxone
Buprenorphine naloxone is a combination of medications administered for the treatment of opiate agonist dependence; a variety of sublingual and buccal products are available.
Buprenorphine is a semisynthetic mixed opiate agonist-antagonist and naloxone is an opiate antagonist.
Buprenorphine exhibits a ceiling to its pharmacological effects; thus, the danger of overdose, abuse liability, and toxicity from buprenorphine may be less than with full opioid agonists.
The low-dose naloxone component mitigates abuse potential by injection. As a result, buprenorphine; naloxone is advantageous for maintenance therapy in the setting of unsupervised opiate dependence therapy.
Buprenorphine was the first medication approved for in-office treatment of opioid dependence under the federal Drug Addiction Treatment Act (DATA), and physicians using buprenorphine; naloxone for the treatment of opiate dependence must comply with the requirements of DATA.
Induction therapy with buprenorphine; naloxone is only indicated in patients with dependence on heroin or other short-acting opioids.
Buprenorphine monotherapy is recommended for induction therapy in patients with dependence on long-acting opioids, since these patients may be more susceptible to precipitated and prolonged withdrawal during induction and naloxone in the combination products is absorbed in small amounts and could worsen withdrawal.
Following induction, patients with dependence on long-acting opioids may be transitioned to buprenorphine; naloxone.
Methadone and buprenorphine produce similar efficacy at improving outcomes during maintenance therapy; buprenorphine is typically associated with less sedation and respiratory depression during induction therapy.
Some literature suggests that methadone maintenance programs might be associated with higher rates of patient retention.
Indications
- opiate agonist dependence
For the treatment of opiate agonist dependence
for induction treatment in patients dependent on heroin or other short-acting opioid products who are in opioid withdrawal
Side Effects
- abdominal pain
- adrenocortical insufficiency
- amenorrhea
- anaphylactic shock
- anaphylactoid reactions
- angioedema
- anxiety
- apnea
- asthenia
- back pain
- blurred vision
- bronchospasm
- chills
- coma
- constipation
- cough
- depression
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- erythema
- fatigue
- fever
- glossitis
- gonadal suppression
- headache
- hepatic encephalopathy
- hepatic failure
- hepatic necrosis
- hepatitis
- hyperbilirubinemia
- hyperhidrosis
- hypoesthesia
- hyponatremia
- hypoxia
- impaired cognition
- impotence (erectile dysfunction)
- increased intracranial pressure
- infection
- infertility
- insomnia
- jaundice
- lacrimation
- lethargy
- libido decrease
- miosis
- nausea
- neonatal abstinence syndrome
- neonatal respiratory depression
- oral ulceration
- orthostatic hypotension
- palpitations
- peripheral edema
- peripheral vasodilation
- pharyngitis
- physiological dependence
- pruritus
- psychological dependence
- psychomotor impairment
- rash
- respiratory arrest
- respiratory depression
- rhinitis
- rhinorrhea
- serotonin syndrome
- SIADH
- stomatitis
- urticaria
- vomiting
- withdrawal
Monitoring Parameters
- LFTs
Contraindications
- abrupt discontinuation
- accidental exposure
- acute abdomen
- adrenal insufficiency
- alcoholism
- asthma
- biliary tract disease
- breast-feeding
- chronic obstructive pulmonary disease (COPD)
- CNS depression
- coadministration with other CNS depressants
- coma
- cor pulmonale
- depression
- driving or operating machinery
- emphysema
- ethanol ingestion
- ethanol intoxication
- geriatric
- head trauma
- hepatic disease
- hepatitis
- hypothyroidism
- hypoxemia
- increased intracranial pressure
- infertility
- intracranial mass
- intravenous administration
- labor
- myxedema
- neonatal opioid withdrawal syndrome
- obesity
- obstetric delivery
- opioid-naive patients
- orthostatic hypotension
- pain
- pancreatitis
- potential for overdose or poisoning
- pregnancy
- psychosis
- pulmonary disease
- reproductive risk
- requires an experienced clinician
- respiratory depression
- respiratory insufficiency
- scoliosis
- sleep apnea
- substance abuse
Interactions
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Tramadol
- Aclidinium; Formoterol
- Acrivastine; Pseudoephedrine
- Albuterol
- Albuterol; Ipratropium
- Alfentanil
- Alfuzosin
- Almotriptan
- Alosetron
- Alprazolam
- Alvimopan
- Amifampridine
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Amiodarone
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amoxapine
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amprenavir
- Anagrelide
- Anticholinergics
- Apalutamide
- Apomorphine
- Aprepitant, Fosaprepitant
- Arformoterol
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir
- Atazanavir; Cobicistat
- Atomoxetine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Azithromycin
- Baclofen
- Barbiturates
- Bedaquiline
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Boceprevir
- Bosentan
- Brexpiprazole
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide; Formoterol
- Bumetanide
- Buprenorphine
- Bupropion; Naltrexone
- Buspirone
- Butorphanol
- Cannabidiol
- Capsaicin; Metaxalone
- Carbamazepine
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Cenobamate
- Ceritinib
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chloral Hydrate
- Chloramphenicol
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chloroquine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorzoxazone
- Cimetidine
- Ciprofloxacin
- Cisapride
- Citalopram
- Clarithromycin
- Class IA Antiarrhythmics
- Clemastine
- Clobazam
- Clofazimine
- Clomipramine
- Clonazepam
- Clorazepate
- Clozapine
- Cobicistat
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Conivaptan
- Crizotinib
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Daclatasvir
- Dalfopristin; Quinupristin
- Dantrolene
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasatinib
- Degarelix
- Delavirdine
- Desflurane
- Desipramine
- Desvenlafaxine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmedetomidine
- Dextromethorphan
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diltiazem
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Doxepin
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Droperidol
- Duloxetine
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix
- Elbasvir; Grazoprevir
- Eletriptan
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Encorafenib
- Enflurane
- Entacapone
- Entrectinib
- Enzalutamide
- Eribulin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esketamine
- Eslicarbazepine
- Estazolam
- Eszopiclone
- Ethacrynic Acid
- Ethanol
- Etomidate
- Etravirine
- Ezogabine
- Fedratinib
- Fentanyl
- Fingolimod
- Flecainide
- Flibanserin
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Fluvoxamine
- Formoterol
- Formoterol; Mometasone
- Fosamprenavir
- Foscarnet
- Fosphenytoin
- Fospropofol
- Frovatriptan
- Furosemide
- Gabapentin
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gilteritinib
- Glasdegib
- Glycopyrrolate; Formoterol
- Goserelin
- Granisetron
- grapefruit juice
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Halogenated Anesthetics
- Haloperidol
- Halothane
- Histrelin
- Homatropine; Hydrocodone
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Ibutilide
- Idelalisib
- Iloperidone
- Imatinib
- Imipramine
- Indacaterol
- Indacaterol; Glycopyrrolate
- Indapamide
- Indinavir
- Inotuzumab Ozogamicin
- Isavuconazonium
- Isoflurane
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ivacaftor
- Ivosidenib
- Ketamine
- Ketoconazole
- Lapatinib
- Lasmiditan
- Lefamulin
- Lenvatinib
- Lesinurad
- Lesinurad; Allopurinol
- Letermovir
- Leuprolide
- Leuprolide; Norethindrone
- Levalbuterol
- Levocetirizine
- Levofloxacin
- Levomethadyl
- Levomilnacipran
- Levorphanol
- Linezolid
- Lithium
- Lofexidine
- Loop diuretics
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lorazepam
- Lorlatinib
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Lumateperone
- Lurasidone
- Macimorelin
- Magnesium Salts
- Maprotiline
- Meclizine
- Mefloquine
- Meperidine
- Meperidine; Promethazine
- Meprobamate
- Metaproterenol
- Metaxalone
- Methadone
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methocarbamol
- Methylene Blue
- Methylnaltrexone
- Metronidazole
- Midazolam
- Midostaurin
- Mifepristone
- Milnacipran
- Minocycline
- Mirtazapine
- Mitotane
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Moxifloxacin
- Nabilone
- Nalbuphine
- Naldemedine
- Nalmefene
- Naloxegol
- Naltrexone
- Naproxen; Sumatriptan
- Naratriptan
- Nefazodone
- Nelfinavir
- Netupitant, Fosnetupitant; Palonosetron
- Nevirapine
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Olodaterol
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Ondansetron
- Opiate Agonists-Antagonists
- Oritavancin
- Orphenadrine
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxazepam
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Palbociclib
- Paliperidone
- Panobinostat
- Paroxetine
- Pasireotide
- Pazopanib
- Pentamidine
- Pentazocine
- Pentazocine; Naloxone
- Perphenazine
- Perphenazine; Amitriptyline
- Phenylephrine; Promethazine
- Phenytoin
- Pimavanserin
- Pimozide
- Pirbuterol
- Pitolisant
- Posaconazole
- Potassium-sparing diuretics
- Pramipexole
- Pregabalin
- Primaquine
- Prochlorperazine
- Promethazine
- Propafenone
- Propoxyphene
- Protriptyline
- Quazepam
- Quetiapine
- Quinine
- Ramelteon
- Ranolazine
- Rasagiline
- Remifentanil
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifamycins
- Rifapentine
- Rilpivirine
- Risperidone
- Ritonavir
- Rizatriptan
- Romidepsin
- Ropinirole
- Rotigotine
- Rufinamide
- Salmeterol
- Saquinavir
- Serotonin-Receptor Agonists
- Sertraline
- Sevoflurane
- Short-acting beta-agonists
- Simeprevir
- Siponimod
- Solifenacin
- Sorafenib
- Sotalol
- Spironolactone
- St. John’s Wort, Hypericum perforatum
- Streptogramins
- Sufentanil
- Sumatriptan
- Sunitinib
- Suvorexant
- Tacrolimus
- Tamoxifen
- Tapentadol
- Tasimelteon
- Telaprevir
- Telavancin
- Telithromycin
- Telotristat Ethyl
- Temazepam
- Terbutaline
- Tetrabenazine
- Tezacaftor; Ivacaftor
- Thiazide diuretics
- Thiethylperazine
- Thioridazine
- Tiotropium; Olodaterol
- Tipranavir
- Tizanidine
- Tolcapone
- Tolterodine
- Toremifene
- Torsemide
- Tramadol
- Trandolapril; Verapamil
- Trazodone
- Triamterene
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Trimethobenzamide
- Trimipramine
- Triprolidine
- Triptorelin
- Trospium
- Umeclidinium; Vilanterol
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Verapamil
- Vigabatrin
- Vilazodone
- Voriconazole
- Vorinostat
- Vortioxetine
- Zafirlukast
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolmitriptan
- Zolpidem
