Suboxone is a brand of a medication that contains a combination of buprenorphine and naloxone as active ingredients.
Suboxone is used for the treatment of addiction to narcotics (opiates). It is not like medicine to relieve pain.
Buprenorphine is a partial opioid agonist, which reduces the symptoms of opiate withdrawal, while naloxone refers to the class of drugs called opioid antagonists, which reverse the effects of narcotics.
Suboxone is utilized as part of a treatment program that usually involves changes in lifestyle, counseling and other interventions. It is accessible in the form of sublingual pills in doses of buprenorphine of 8 mg and a dose of naloxone of 2 mg.
Buprenorphine is metabolized in the liver and discharged in the urine and stool. Naloxone is also metabolized in the liver. Metabolic reactions in the liver create suboxone metabolites that can remain in the body for longer than the drug itself. Modern drug tests can detect such metabolites even after eight days.
After sublingual administration of Suboxone, buprenorphine has an elimination half-life ranging from 24 to 42 hours, and naloxone has an elimination half-life ranging from 2 to 12 hours.
Buprenorphine becomes detectable in the urine only 40 minutes after consumption, and if used for a prolonged period, the drug may appear in laboratory tests up to 2 weeks later.
The drug and its metabolites can also accumulate in the hair follicles and can be detected for 1-3 months; however, this is a reliable form of drug testing.
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Buprenorphine exhibits analgesic effects due to its partial agonist activity in mu-opioid receptors in the brain. Buprenorphine is also an antagonist of the kappa opioid receptor.
Partial agonist activity means that the opioid receptor antagonist (such as naloxone) only partially reverses the effects of buprenorphine.
The binding to the mu and kappa receptors results in hyperpolarization of the neural membrane and reduces the excitability of the neurons. Buprenorphine slowly disunites from its receptor and has longer effects compared to morphine.
It has a very flat level of causing physical dependence. The half-life of the buprenorphine receptor is approximately 40 minutes, which is much longer than morphine, whose half-life is counted in milliseconds.
Naloxone is an opioid antagonist drug that prevents or nullifies the effects of opioid drugs, such as respiratory depression, hypotension, pupillary constriction, and sedation.
Besides, it can modify the dysphoric and psychotomimetic effects of agonist-antagonist drugs such as pentazocine. It is mostly a pure narcotic antagonist that does not have “agonistic” or morphine characteristics.
Although the mechanism of action of naloxone is still not fully understood, some evidence suggests that naloxone antagonizes the effects of opioids competing for the same receptor sites, especially the mu opioid receptor.
Recent findings show that naloxone binds to the three opioid receptors (mu, kappa, and gamma) but the most durable binding is to the mu receptor.
Patients should inform their doctor if any of the following side effects become severe or does not go away:
Patients should reach their doctor promptly if they experience any of the following serious side effects:
The pill should be placed under the tongue and dissolved. It will take several minutes for complete dissolution. Patients should follow the directions on the prescription label.
Medications should be left in the sealed foil packet until patients are ready to use it. If the dose requires taking once more than two tablets, place all the pills at the same time under the tongue, or if you can not put more than two tablets comfortably, place two tablets at a time under the tongue.
Both way, you should keep the tablets under your tongue until they dissolve completely. Do not swallow or chew this medication. This medicine should be taken at proper intervals. Patients should not take this medication more often than indicated.
Take the missed dose of Suboxone as soon as you remember it. Skip the missed dose if it is almost time for your next scheduled dose. Do not take additional medications to make up for the forgotten dose.
Patients should seek emergency medical attention immediately or call the Poison Help line at 1-800-222-1222 if they take an overdose of Suboxone.
An overdose of Suboxone can be fatal, especially in a child or another person who uses the medication without a prescription. Symptoms of overdose include severe drowsiness, blurred vision, difficulty speaking, thinking problems, loss of coordination and weak or shallow breathing and weakness or lameness.
Patients should never take Suboxone along with alcohol. If buprenorphine is used together with central nervous system depressants, such as alcohol, there will be an increased risk of an overdose of buprenorphine and severe side effects, such as acute respiratory depression, coma and death will occur.
The most common reported cases have occurred mainly in the context of maintenance therapy with buprenorphine for patients with opioid addiction, and many involved the abuse or ill-usage of buprenorphine, including intravenous self-injection. The definite mechanism of interaction between alcohol and buprenorphine is still unexplained,
The data from animal studies have not been able to find the evidence of teratogenicity of Suboxone; however, it is known that the use of buprenorphine has been linked to fetotoxicity and painful delivery, including implantation losses and lowered postnatal survival in animals.
However, there are no verified data in human pregnancy. The FDA pregnancy category is C, which means that: Animal reproduction studies have shown side effects in the fetus, and there are no adequate and well-controlled studies in humans, but the potential benefits may justify the use of the drug in women pregnant despite the potential risks.