SAFETY ALERT FOR ORAL BUPRENORPHINE
In January 2022, the Food and Drug Administration (FDA) issued a
Chronic pain is pain that lasts for a long time. Opioids are strong medications prescribed to help relieve chronic pain. While they’re effective, these drugs can also be habit-forming and lead to addiction and dependence. So they must be used carefully.
Methadone and Suboxone are both opioids. While methadone is used to treat chronic pain and opioid addiction, Suboxone is only approved to treat opioid dependence. Read on to learn more about how these two drugs compare.
Methadone is a generic drug. Suboxone is the brand name of the medication buprenorphine/naloxone. Find out more about them below.
| methadone | buprenorphine-naloxone |
| Dolophine, Methadone HCl Intensol, Methadose | Suboxone, Bunavail, Zubsolv |
| chronic pain, opioid addiction | opioid dependence |
| yes, it’s a Schedule II controlled substance | yes, it’s a Schedule III controlled substance |
| yes† | yes† |
| yes¥ | yes¥ |
* A controlled substance is a drug that is regulated by the government. If you take a controlled substance, your doctor must closely supervise your use. Never give a controlled substance to anyone else. Schedule II drugs have higher potential for addiction than Schedule III drugs.
† If you’ve been taking this drug for longer than a few weeks, don’t stop taking it without talking to your doctor. You’ll need to taper off the drug slowly to avoid withdrawal symptoms, such as anxiety, sweating, nausea, and trouble sleeping.
¥ This drug has a high misuse potential. This means you can get addicted to it. Be sure to take it exactly as your doctor tells you to. If you have questions or concerns, talk with your doctor.
Addiction is different from dependence.
Addiction occurs when you have uncontrollable cravings that cause you to keep using a drug. You can’t stop using the drug even though it leads to harmful results.
Dependence happens when your body physically adapts to a drug and becomes tolerant to it. This leads you to need more of the drug to create the same effect.
Methadone comes in these forms:
- oral tablet
- oral solution
- oral concentrate
- injectable solution
- oral dispersible tablet, which must be dissolved in a liquid before you take it
Brand-name Suboxone comes as an oral film, which can be dissolved under your tongue (sublingual) or placed between your cheek and gums to dissolve (buccal).
Generic versions of buprenorphine/naloxone (the ingredients in Suboxone) are available as an oral film and a sublingual tablet.
Currently, there are large price differences between methadone and both generic and brand name Suboxone. Overall, both brand-name Suboxone and generic buprenorphine/naloxone are more expensive than methadone. For more information on medication prices, see GoodRx.com.
Many insurance companies require a prior authorization for methadone or Suboxone. This means your doctor will need to get approval from your insurance company before the company will pay for the prescription.
There are restrictions on how you can access these medications. These restrictions depend on the type of drug and why it’s being used.
Only methadone is approved to treat chronic pain. Methadone for pain relief is available at some pharmacies, but not all. Talk to your doctor about what pharmacies can fill a methadone prescription to treat chronic pain.
Both methadone and Suboxone can be used to help you get through the detoxification process for opioids.
Detoxification occurs when your body tries to get rid of a drug. During detoxification, you have withdrawal symptoms. Most withdrawal symptoms aren’t life threatening, but they’re very uncomfortable.
This is where methadone and Suboxone come in. They can reduce your withdrawal symptoms and your drug cravings.
Methadone and Suboxone both help manage detoxification, but the process for their use is different.
Treatment with methadone
When you use methadone for addiction treatment, you can only get it from certified opioid treatment programs. These include methadone maintenance clinics.
When starting treatment, you have to go to one of these clinics. A doctor observes you receiving each dose.
Once the clinic doctor decides you’re stable with methadone treatment, they may allow you to take the drug at home between visits to the clinic. If you take the medication at home, you still need to get it from a certified opioid treatment program.
Treatment with Suboxone
For Suboxone, you don’t need to go to a clinic to receive treatment. Your doctor will give you a prescription.
However, they will likely monitor the start of your treatment closely. They may require you to come to their office to get the medication. They may also observe you taking the drug.
If you’re allowed to take the drug at home, your doctor may not give you more than a few doses at a time. Over time, however, your doctor will likely allow you to manage your own treatment.
The charts below list examples of side effects of methadone and Suboxone.
| lightheadedness | ✓ | ✓ |
| dizziness | ✓ | ✓ |
| fainting | ✓ | |
| sleepiness | ✓ | ✓ |
| nausea and vomiting | ✓ | ✓ |
| sweating | ✓ | ✓ |
| constipation | ✓ | ✓ |
| stomach pain | ✓ | |
| numbness in your mouth | ✓ | |
| swollen or painful tongue | ✓ | |
| redness inside your mouth | ✓ | |
| trouble paying attention | ✓ | |
| faster or slower heart rate | ✓ | |
| blurry vision | ✓ |
| addiction | ✓ | ✓ |
| severe breathing problems | ✓ | ✓ |
| heart rhythm problems | ✓ | |
| problems with coordination | ✓ | |
| severe stomach pain | ✓ | |
| seizures | ✓ | |
| allergic reaction | ✓ | ✓ |
| opioid withdrawal | ✓ | |
| low blood pressure | ✓ | |
| liver problems | ✓ |
If you take more methadone or Suboxone than your doctor or clinic prescribes, it can cause an overdose. This can even lead to death. It’s critical that you take your drug exactly as directed.
Because both methadone and Suboxone are opioids, they can cause addiction and withdrawal symptoms. As a Schedule II drug, methadone has a higher risk of misuse than Suboxone.
Symptoms of withdrawal from either medication can vary widely in severity from one person to another. Typically, withdrawal from methadone can last
Symptoms of opioid withdrawal can include:
- shaking
- sweating
- feeling hot or cold
- runny nose
- watery eyes
- goose bumps
- diarrhea
- nausea or vomiting
- muscle aches or muscle cramps
- trouble sleeping (insomnia)
Don’t stop taking either drug on your own. If you do, your withdrawal symptoms will get worse.
If you need to stop taking your drug, your doctor will slowly lower your dosage over time to help prevent withdrawal symptoms. For more information, read about coping with opiate withdrawal or going through methadone withdrawal.
Examples of withdrawal effects from methadone and Suboxone are as follows:
| cravings | ✓ | ✓ |
| trouble sleeping | ✓ | ✓ |
| diarrhea | ✓ | ✓ |
| nausea and vomiting | ✓ | ✓ |
| depression and anxiety | ✓ | ✓ |
| muscle aches | ✓ | ✓ |
| fever, chills, and sweating | ✓ | |
| hot and cold flashes | ✓ | ✓ |
| tremors | ✓ | ✓ |
| hallucinations (seeing or hearing things that aren’t there) | ✓ | |
| headache | ✓ | |
| trouble concentrating | ✓ |
Suboxone and methadone can also cause withdrawal syndrome in a newborn if you take either drug during pregnancy. You may notice:
- crying more than usual
- irritability
- overactive behaviors
- trouble sleeping
- high-pitched cry
- tremor
- vomiting
- diarrhea
- not being able to gain weight
Both methadone and Suboxone can interact with other medications. In fact, methadone and Suboxone share many of the same drug interactions.
Examples of drugs that methadone and Suboxone may interact with include:
- benzodiazepines, such as alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin)
- sleep aids, such as zolpidem (Ambien), eszopiclone (Lunesta), and temazepam (Restoril)
- anesthesia medications
- other opioids, such as buprenorphine (Butrans) and butorphanol (Stadol)
- antifungal medications, such as ketoconazole, fluconazole (Diflucan), and voriconazole (Vfend)
- antibiotics, such as erythromycin (Erythrocin) and clarithromycin (Biaxin)
- antiseizure drugs, such as phenytoin (Dilantin), phenobarbital (Solfoton), and carbamazepine (Tegretol)
- HIV drugs, such as efavirenz (Sustiva) and ritonavir (Norvir)
In addition to this list, methadone also interacts with other medications. These include:
- heart rhythm drugs, such as amiodarone (Pacerone)
- antidepressants, such as amitriptyline, citalopram (Celexa), and quetiapine (Seroquel)
- monoamine oxidase inhibitors (MAIOs), such as selegiline (Emsam) and isocarboxazid (Marplan)
- anticholinergic medications, such as benztropine (Cogentin), atropine (Atropen), and oxybutynin (Ditropan XL)
Methadone and Suboxone can cause problems if you take them when you have certain health issues. If you have any of these, you should discuss your safety with your doctor before taking methadone or Suboxone:
- kidney disease
- liver disease
- breathing problems
- misuse of other drugs
- alcohol addiction
- mental health problems
Also talk to your doctor before taking methadone if you have:
- heart rhythm problems
- seizures
- stomach problems such as bowel blockage or narrowing of your intestines
Talk to your doctor before taking Suboxone if you have:
- adrenal gland problems
(Video) Doctor Explains the Difference Between Methadone, Naltrexone (Vivitrol), and Suboxone
Methadone and Suboxone have many similarities and some key differences. Some of the more important differences between these drugs may include their:
- drug forms
- risk of addiction
- cost
- accessibility
- side effects
- drug interactions
Your doctor can tell you more about these differences. If you need treatment for opioid addiction, your doctor is the best place to start. They can recommend the best drug to help you get healthy.
Q:
Why can opioid withdrawal occur as a side effect of Suboxone?
Anonymous patient
A:
Taking Suboxone can lead to opioid withdrawal symptoms, especially if the dose is too high. This is because Suboxone contains the drug naloxone. This drug is added to Suboxone to discourage people from injecting or snorting it.
If you inject or snort Suboxone, the naloxone may cause withdrawal symptoms. But if you take Suboxone by mouth, your body absorbs very little of the naloxone component, so the risk of withdrawal symptoms is low.
Taking high doses of Suboxone by mouth may still cause withdrawal symptoms, however.
Healthline Medical TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
FAQs
Does methadone work better than Suboxone? ›
Which Has More Effectiveness, Methadone or Suboxone? Professionals measure the effectiveness of a MAT medication by its ability to reduce the patient's opioid use. In this sense, Suboxone and methadone have similar results. Research shows that methadone and Suboxone have equal success rates in lowering opiate use.
What are the different strengths of methadone? ›- 5mg.
- 10mg.
- 40mg.
▶ Buprenorphine has a very high affinity for mu receptors. Thus, it displaces morphine, methadone, and other full agonist opioids from the receptor. ▶ Buprenorphine dissociates slowly from the mu receptor. Thus, it is able to block the effects of other opioids, such as heroin.
How does Suboxone interact with methadone? ›However, Suboxone binds more strongly to receptors in the brain than methadone. [2] This means that if Suboxone and methadone are mixed, Suboxone will kick methadone off the opioid receptors in the brain. This will cause precipitated withdrawal.
Is methadone more sedating than buprenorphine? ›Many patients report less sedation on buprenorphine than on methadone. Research evidence suggests that buprenorphine has minimal effect on psychomotor performance (Lenne et al 2003; Mintzer et al 2004), and less effect than methadone (Soyka et al 2005) or slow release oral morphine (Giacomuzzi et al 2005).
Why is methadone less euphoric? ›The investigators found that the opioid-galanin receptor heteromers determine the different effects of methadone as compared to morphine and fentanyl, showing methadone with a weaker ability to activate the dopaminergic system linked to the euphoric effects of opioids.
Is 120 mg of methadone a lot? ›Patients should be reviewed prior to each dose increase. The average effective dose of methadone is 60–120 mg.
How much is 10 mg methadone? ›The cost for Methadose oral concentrate (10 mg/mL) is around $101 for a supply of 1000 milliliters, depending on the pharmacy you visit.
How long do people stay on methadone? ›According to the National Institute on Drug Abuse publication Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), the length of methadone treatment should be a minimum of 12 months. Some patients may require long-term maintenance.
Which is safer buprenorphine or methadone? ›Buprenorphine also has less risk of causing problems in heart rhythm. When treatment is stopped, buprenorphine causes milder withdrawal than methadone. Because buprenorphine is safer to use than methadone, it is easier to prescribe and doesn't require visits to special methadone clinics.
Is it hard to switch from methadone to Suboxone? ›
Patients find it very challenging to transfer from methadone to Suboxone as a result of methadone's long half-life and strong attachment to the opioid receptors. Patients need to reduce their dose down to thirty to forty milligrams of methadone then take their last dose 72 hours before taking Suboxone.
What is considered high doses of methadone? ›Adults—At first, 20 to 30 milligrams (mg) taken as a single dose per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 40 mg per day. Do not take more than your prescribed dose in 24 hours.
How long after taking methadone can you start Suboxone? ›Buprenorphine may be started 36-72 hours after the last methadone dose, but it is advisable to observe for objective signs of withdrawal (Clinical Opiate Withdrawal Scale of 13-15) and not rely only on time lapsed since the last methadone dose.
What meds Cannot be taken with Suboxone? ›by Drugs.com
Drugs that can have negative effects when taken with Suboxone include: Benzodiazepines, such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam) and Restoril (temazepam).
Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment. Do not allow anyone else to take your medication. Methadone may harm or cause death to other people who take your medication, especially children.
What does grapefruit do to methadone? ›Grapefruit juice inhibits the metabolism of methadone, raising its serum levels. To our knowledge, this is the first reported case in which the interaction between grapefruit juice and methadone was significant enough to cause an opioid toxidrome.
What does it feel like to be on methadone? ›Methadone will cause feelings of relaxation and reduce pain, but it will not give you the same high or euphoric feeling as heroin. It works in treating heroin addiction by reducing the withdrawal symptoms and cravings. It is long acting and this means it stays in your body a lot longer than morphine and heroin.
Why do I sleep so much on methadone? ›Why Does Methadone Make You Tired All Day? Drowsiness is one of methadone's characteristic side effects. Extreme fatigue is common after taking methadone because the medication stimulates changes in brain chemistry, which can interfere with sleep regulation.
What drug does methadone mimic? ›Similar to morphine and other morphine-like agents, methadone mimics the actions of endogenous peptides at CNS opioid receptors, primarily the mu-receptor, resulting in characteristic morphine-like effects including analgesia, euphoria, sedation, respiratory depression, miosis, bradycardia and physical dependence.
Does methadone have a ceiling effect? ›The first is a full agonist and the one typically used for treatment is methadone. It most closely resembles heroin and can remain in the body for up to 59 hours. It does not have a drug ceiling and is most useful for treating patients who have been using substances for a long period of time.
Is methadone the best treatment? ›
Is methadone an effective treatment option? According to the U.S. Centers for Disease Control and Prevention (CDC), treatment that uses methadone for opioid addiction recovery is the safest and most effective form of treatment currently available.
Does Suboxone cancel methadone? ›Yes, Suboxone blocks methadone. Methadone and Suboxone are both opioid medications. Methadone is a full opioid agonist, meaning it fully activates opioid receptors. Suboxone is a partial opioid agonist, so it partially turns opioid receptors on.
Is 300 mg of methadone lethal? ›The lethal dose of methadone is estimated at 50 mg for an opiate-naive adult.
How long before methadone loses its potency? ›Methadone was stable (loss of potency, less than 5%) for up to 17, 11, 9, and 8 days when stored at 20-25 degrees C in Kool-Aid, Tang, apple juice, and Crystal Light, respectively, and for up to 29 days when stored at 20-25 degrees C in Crystal Light plus sodium benzoate.
Does Suboxone start working immediately? ›It usually takes 20-45 min for the medication to start to work. Wait 1-3 hours before your 2nd dose. Are you in withdrawal? Before starting Suboxone® (buprenorphine/naloxone) you need to be in withdrawal (dope-sick).
Can you take anything for pain while on Suboxone? ›Your Suboxone treatment may not be compatible with opioid pain medications, so your provider will make suggestions taking that into account. Instead of opioids, many clinicians will recommend a nonsteroidal anti-inflammatory drug (NSAID) like: ibuprofen (popular brands include Advil, Motrin, Nuprin)
What are the negative side effects of Suboxone? ›Side effects of Suboxone may include dizziness or blurred vision, drowsiness, headache, back pain, tongue pain, numbness or tingling, increased sweating, nausea, vomiting, constipation, and insomnia.
How do I know if I need more Suboxone? ›If you are taking buprenorphine (Suboxone®) for pain, and you are not taking any other opioids, the dose may need to be increased if you are still in pain and it isn't well controlled. The lowest dose for pain can be 2 mg. For chronic pain, you would typically be taking a dose three times a day.
Does gabapentin intensify methadone? ›Ohio has reported the use of gabapentin by addicts to ease withdrawal symptoms, as well as those on methadone to amplify the effects of methadone. Users say it intensifies the methadone, and gives a semi-euphoric feeling.
Is methadone the best treatment? ›Is methadone an effective treatment option? According to the U.S. Centers for Disease Control and Prevention (CDC), treatment that uses methadone for opioid addiction recovery is the safest and most effective form of treatment currently available.
Why is methadone beneficial? ›
Benefits of methadone therapy include: Reduction in infectious disease due to stopping opiate abuse, particularly injection drug abuse. Reduction in criminal activity due to stopping illicit drug use. Overall improvement in quality of life.
What is better methadone used for? ›Methadone works to treat pain by changing the way the brain and nervous system respond to pain. It works to treat people who were addicted to opiate drugs by producing similar effects and preventing withdrawal symptoms in people who have stopped using these drugs.
Which is safer buprenorphine or methadone? ›Buprenorphine also has less risk of causing problems in heart rhythm. When treatment is stopped, buprenorphine causes milder withdrawal than methadone. Because buprenorphine is safer to use than methadone, it is easier to prescribe and doesn't require visits to special methadone clinics.
How long do people stay on methadone? ›According to the National Institute on Drug Abuse publication Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), the length of methadone treatment should be a minimum of 12 months. Some patients may require long-term maintenance.
What is a good mg of methadone? ›Adults—At first, 20 to 30 milligrams (mg) taken as a single dose per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 40 mg per day. Do not take more than your prescribed dose in 24 hours.
What should you not take with methadone? ›What should I avoid while taking methadone? Avoid drinking alcohol, using sedatives, or other opioid pain medications (such as codeine, hydrocodone, oxycodone, or morphine), or using illegal drugs while you are taking methadone. They may increase adverse effects (e.g., sedation, overdose, death) of the medication.
Does methadone make you weaker? ›Drowsiness is one of methadone's characteristic side effects. Extreme fatigue is common after taking methadone because the medication stimulates changes in brain chemistry, which can interfere with sleep regulation.
Why would someone take methadone daily? ›Methadone is a medicine used to treat heroin dependence. It is taken daily to relieve heroin withdrawal symptoms and reduce cravings for heroin. The aim of methadone maintenance treatment is to help you reduce your illicit drug use.
Why is methadone not prescribed? ›Counseling Patients
Pain relief does not last for as long as methadone stays in the body; therefore, patients should not take more methadone than prescribed because levels can accumulate and cause death. Methadone can cause life-threatening changes in breathing and heart rate.
Patients find it very challenging to transfer from methadone to Suboxone as a result of methadone's long half-life and strong attachment to the opioid receptors. Patients need to reduce their dose down to thirty to forty milligrams of methadone then take their last dose 72 hours before taking Suboxone.
Does methadone have a ceiling effect? ›
The first is a full agonist and the one typically used for treatment is methadone. It most closely resembles heroin and can remain in the body for up to 59 hours. It does not have a drug ceiling and is most useful for treating patients who have been using substances for a long period of time.