Buprenorphine Naloxone

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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

  1. abdominal pain
  2. adrenocortical insufficiency
  3. amenorrhea
  4. anaphylactic shock
  5. anaphylactoid reactions
  6. angioedema
  7. anxiety
  8. apnea
  9. asthenia
  10. back pain
  11. blurred vision
  12. bronchospasm
  13. chills
  14. coma
  15. constipation
  16. cough
  17. depression
  18. diarrhea
  19. dizziness
  20. drowsiness
  21. dyspepsia
  22. dyspnea
  23. elevated hepatic enzymes
  24. erythema
  25. fatigue
  26. fever
  27. glossitis
  28. gonadal suppression
  29. headache
  30. hepatic encephalopathy
  31. hepatic failure
  32. hepatic necrosis
  33. hepatitis
  34. hyperbilirubinemia
  35. hyperhidrosis
  36. hypoesthesia
  37. hyponatremia
  38. hypoxia
  39. impaired cognition
  40. impotence (erectile dysfunction)
  41. increased intracranial pressure
  42. infection
  43. infertility
  44. insomnia
  45. jaundice
  46. lacrimation
  47. lethargy
  48. libido decrease
  49. miosis
  50. nausea
  51. neonatal abstinence syndrome
  52. neonatal respiratory depression
  53. oral ulceration
  54. orthostatic hypotension
  55. palpitations
  56. peripheral edema
  57. peripheral vasodilation
  58. pharyngitis
  59. physiological dependence
  60. pruritus
  61. psychological dependence
  62. psychomotor impairment
  63. rash
  64. respiratory arrest
  65. respiratory depression
  66. rhinitis
  67. rhinorrhea
  68. serotonin syndrome
  69. SIADH
  70. stomatitis
  71. urticaria
  72. vomiting
  73. 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

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