Dosing Suboxone - Getting it Right

Suboxone is a popular drug therapy that contains buprenorphine and nalaxone. It has various clinical uses, and its dosage depends primarily upon the reason for it being prescribed. The drug is available as a sublingual film that can be placed under the tongue or as a tablet, and as a controlled substance needs to be prescribed by a healthcare professional who is qualified to do so.

The primary use of suboxone is managing opioids withdrawal and cravings. As such, the broad range of prescription dose lies between 4mg to 24mg daily. It is administered as a once-a-day dose and is used as a maintenance treatment.

Maintenance therapy

In individuals who are dependent on opioids, a gentle withdrawal phase must be observed before they are commenced on suboxone. Prior to starting sublingual film (or tablet) therapy, patients must be prescribed a short course of sublingual buprenorphine alone as a part of the induction phase. The target for buprenorphine alone is 12mg - 16mg once a day.

Following this, they can be commenced on suboxone, starting at a small dose at first but gradually adjusting the dose at increments of 2mg/0.5mg (buprenorphine/nalaxone) until the required dose is reached. The dose that is recommended for maintenance is 16/4mg as a once a day dose.

Constant monitoring

During the induction and maintenance phases, it is important for both the patient and the healthcare professional to monitor the progress of the patient. If the patient is being managed in a community setting rather than at hospital, then frequent home visits may be required during the initial stages. Patients may require counselling to go side by side with drug therapy.

Depending on how patients progress over time, they may require either continued treatment or a slow tapering of the dose. Both these treatments are best offered with counselling so that any relapses can be dealt with swiftly and effectively.

Patients may need periodic urine tests to ensure that they are not abusing illicit drugs while on suboxone. If any evidence that the patient is using illicit drugs emerges again, then treatment may need to be restarted after a detailed evaluation. If required, more advanced, specialist intervention may be required.

In case of a change

In the event of a change needed from sublingual film to sublingual tablets, patients are usually prescribed the same dose again. However, sometimes doses may vary as the availability of the drug from a film is higher than that obtained from a tablet.

Suboxone dosing must be done by a trained professional with experience in managing opioids withdrawal. Treatment requires constant monitoring in conjunction with counselling to offer the best possible outcome for the patient.