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.
|What is the generic name?||methadone||buprenorphine-naloxone|
|What are the brand-name versions?||Dolophine, Methadone HCl Intensol, Methadose||Suboxone, Bunavail, Zubsolv|
|What does it treat?||chronic pain, opioid addiction||opioid dependence|
|Is this a controlled substance?*||yes, it’s a Schedule II controlled substance||yes, it’s a Schedule III controlled substance|
|Is there a risk of withdrawal with this drug?||yes†||yes†|
|Does this drug have potential for misuse?||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.
|Common side effects||Methadone||Suboxone|
|nausea and vomiting||✓||✓|
|numbness in your mouth||✓|
|swollen or painful tongue||✓|
|redness inside your mouth||✓|
|trouble paying attention||✓|
|faster or slower heart rate||✓|
|Serious side effects||Methadone||Suboxone|
|severe breathing problems||✓||✓|
|heart rhythm problems||✓|
|problems with coordination||✓|
|severe stomach pain||✓|
|low blood pressure||✓|
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:
- feeling hot or cold
- runny nose
- watery eyes
- goose bumps
- 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:
|nausea and vomiting||✓||✓|
|depression and anxiety||✓||✓|
|fever, chills, and sweating||✓|
|hot and cold flashes||✓||✓|
|hallucinations (seeing or hearing things that aren’t there)||✓|
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
- overactive behaviors
- trouble sleeping
- high-pitched cry
- 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
- stomach problems such as bowel blockage or narrowing of your intestines
Talk to your doctor before taking Suboxone if you have:
- adrenal gland problems
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
- 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.
Why can opioid withdrawal occur as a side effect of Suboxone?Anonymous patient
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.