naabt masthead for buprenorphine site

The National Alliance of Advocates
for Buprenorphine Treatment

Buprenorphine (Suboxone®, Subutex®3, Zubsolv™4, Bunavail™5) is an opioid medication used to treat opioid addiction in the privacy of a physician's office.1 Buprenorphine can be dispensed for take-home use, by prescription.1 This, in addition to the pharmacological and safety profile of buprenorphine, makes it an attractive treatment for patients addicted to opioids.2

Common Buprenorphine Side Effects

Headache, Constipation, Dry Mouth

Headache:

glass of water with lemons

Headache is one of the most commonly reported buprenorphine side effects. A common remedy for headaches is aspirin or other OTC pain remedies with a glass of water; but water alone may be all that's needed. Medications, including laxatives and all opioids, can contribute to dehydration; and one of the first symptoms of dehydration is a headache. Just by staying hydrated throughout the day may be enough to solve the headache side effect, and reduce some of the other side effects as well.

Be mindful there are other things that can cause headaches such as caffeine and nicotine withdrawals. Drinking plenty of water is the easiest first step in trying to figure out the cause of headaches. But if the headaches persist, consult with a medical professional to be on the safe side.


Constipation:

stool softener and laxative for buprenorphine treatment side effect Many medications can cause constipation, including opioids, but especially long-acting opioids. Fast-acting, short-duration opioids, such as heroin and hydrocodone, produce periods of great effect and periods of lesser effect. It is during those periods of lesser effect that the body is able to produce bowel movements. However, long-acting opioids, such as buprenorphine, methadone and time-released oxycodone, have a continuous influence on the body without the period of lesser effect that would allow for bowel movements. This can lead to chronic constipation if preventative strategies aren't employed.

Constipation can become serious, and, in extreme cases, require surgery, but for most, it's an unnecessary inconvenience and discomfort. Fortunately, it is usually avoidable with OTC remedies, exercise, good diet and good hydration.

stool softener for buprenorphine treatment side effect If drinking more water along with a high fiber diet and increased exercise isn't enough, stool softeners such as docusate sodium (brand name Colace®) which comes in soft gel tablets are an option. This product softens stools and has a lubricating effect, but is not a laxative. Polyethylene glycol 3350 (brand name Miralax®) is a powder that dissolves into drinks and both softens stools and increases the frequency of bowel movements. It works by drawing water into the colon, and for that reason drink plenty of water to avoid dehydration - a contributor to constipation. According to an informal survey conducted online, either one or a combination of both has been effective at relieving most buprenorphine-induced constipation. Avoid harsh and habit-forming laxatives if possible; and, of course, consult your doctor before using any of the remedies mentioned here.

Too late for prevention, I have severe constipation now, what can I do?


biotene bottle

Dry mouth (xerostomia):

This may seem like an innocuous symptom and is not often cited as a buprenorphine side effect, but it can be very serious and very costly.

Saliva is the mouth’s primary defense against tooth decay, gun disease, and maintains the health of the soft and hard tissues in the mouth. Saliva washes away food and other debris, neutralizes acids produced by bacteria in the mouth and provides disease-fighting substances throughout the mouth.

With dry mouth (which is a side effect from all opioids) these benefits are diminished which allows bacteria to multiply and often leads to gingivitis which can lead to periodontitis disease, and eventually bone and tooth loss. - more-

Bacteria in plaque are the main cause of gingivitis and periodontitis. Plaque is a biofilm that continuously forms on the teeth and under the gumline. These bacteria may release toxins, especially below the gumline, that irritate the gum tissue and cause inflammation. Toxins or poisons - produced by the bacteria in plaque as well as the body's "good" enzymes involved in fighting infections - start to break down the bone and connective tissue that hold teeth in place. The gums may eventually break down and separate from the teeth causing a deep space called periodontal pockets. These pockets are very difficult to clean, allowing the bacteria to grow and multiply. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become loose, and tooth loss occurs.

Gum disease is the leading cause of tooth loss in adults, not tooth decay.

Water Flosser

Other contributors to the risk and severity of periodontal gum disease and oral health problems are smoking and diabetes.

According to the CDC, researchers have uncovered potential links between gum disease and other serious health conditions. In people with healthy immune systems, the bacteria in the mouth that makes its way into the bloodstream is usually harmless. But under certain circumstances, these microorganisms are associated with health problems such as stroke and heart disease.

Avoid the pain and cost from the consequences of buprenorphine-induced dry mouth by keeping well hydrated, use OTC treatment for dry-mouth such as Biotene®, and pay especially close attention to good oral hygiene with routine dentist visits. Water flossers may be even more effective than floss at reducing plaque buildup. Preventative oral care might be the single best way to save money associated with your addiction treatment. Do not overlook the importance of it.

Above buprenorphine side effects can occur when dosed correctly. When doses incorrectly however, other symptoms have been reported. Here are some of them.

  • Too high of a dose: lethargy, a medicated feeling ( described as “ cloudy” “foggy” or “ slow”), tiredness, nausea, constricted pupils in low light, a general unmotivated feeling, unjustified feeling of contentment, dehydration (indicated by dark urine)
  • Too low of a dose: sweating, chills, goose bumps, dilated pupils in normal light, diarrhea, cramps, insomnia, nausea, anxiety, depression, dehydration, cravings

The optimal dose of buprenorphine, when prescribed for addiction, is the lowest dose that suppresses cravings and withdrawal symptoms. Dose requirements may change as treatment progresses.

- Read what patients are saying about side effects -

This page was last modified on : 07/05/2014

The Purpose of Buprenorphine Treatment:

To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -

The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization charged with the mission to:

  1. U.S. Food and Drug Administration, FDA Talk Paper, T0238, October 8, 2002, Subutex and Suboxone approved to treat opiate dependence.
  2. Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004.
  3. Subutex Discontinued in the US market in late 2011.
  4. Zubsolv (bup/nx sublingual tablet) FDA approved 7/3/2013 see buprenorphine pipeline graphic
  5. Bunavail (bup/nx bucal film) FDA approved 6/6/2014 see buprenorphine pipeline graphic
  6. Probuphine Rejected by FDA 4/30/2013 - may resubmit in late 2015 - Probuphine denied by FDA