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Suboxone vs Subutex
Introduction
For patients dealing with opioid addiction, certain medications that interact with the opioid receptors in the brain can assist in managing withdrawal symptoms and cravings. Suboxone and Subutex are two such drugs primarily used in medication-assisted treatment for opioid dependence. Both of these medicines contain buprenorphine--a partial opioid agonist that helps to mitigate withdrawal symptoms. However, there is a key difference between them: Suboxone also contains naloxone, an antagonist that blocks the effects of opioids to prevent misuse by causing withdrawal symptoms if attempted to be injected. On the other hand, Subutex does not include naloxone and is typically prescribed during initial stages of treatment under direct supervision of healthcare professionals.
Suboxone vs Subutex Side By Side
| Attribute | Suboxone | Subutex |
|---|---|---|
| Brand Name | Suboxone | Subutex |
| Contraindications | Should not be taken if using or have recently used certain narcotic drugs like methadone or other buprenorphine-containing products due to risk of precipitated withdrawal. | Should not be taken if using or have recently used certain narcotic drugs like methadone or other buprenorphine-containing products due to risk of precipitated withdrawal. |
| Cost | $130 to over $500 for a month's supply, approximately $4–17 per day | $90–200 for 30 tablets, approximately $3-$7/day |
| Generic Name | buprenorphine/naloxone | buprenorphine |
| Most Serious Side Effect | Severe withdrawal symptoms, allergic reactions, distorted vision, liver problems, respiratory issues, low blood pressure | Signs of an allergic reaction, symptoms of opioid withdrawal, breathing problems, light-headedness, unusual thoughts or behavior, liver problems |
| Severe Drug Interactions | Can exacerbate withdrawal symptoms in some individuals, especially if taken with certain narcotics without a proper timeframe. | Can exacerbate withdrawal symptoms in some individuals, especially if taken with certain narcotics without a proper timeframe. |
| Typical Dose | 2/0.5 mg to 24/6 mg per day, with 16/4mg per day being usually sufficient | 2–4 mg/day initially, can be increased to 8-24 mg/day |
What is Suboxone?
Suboxone and Subutex are both brand names for types of buprenorphine, a medication used to treat opioid dependency. Buprenorphine was first approved by the FDA in 1981. The primary difference between Suboxone and Subutex is that Suboxone contains an additional active ingredient: naloxone, an opioid antagonist that blocks the effect of opioids and induces withdrawal symptoms if it's injected or snorted. This is designed as a deterrent from misuse.
Both drugs work by binding to the same receptors in the brain that opioids do, effectively tricking the brain into thinking it has received opioids thus suppressing withdrawal symptoms and reducing cravings. However, they do this without providing the dangerous high associated with substance abuse.
Subutex is typically prescribed during initial treatment stages due to its pure buprenorphine content while Suboxone is more commonly used for maintenance therapy because of its added naloxone component which further reduces potential for misuse.
What conditions is Suboxone approved to treat?
Suboxone and Subutex are both approved for the treatment of opioid dependence:
- Maintenance therapy in patients with a confirmed diagnosis of opioid dependence
- Induction phase treatment, where it helps to suppress withdrawal symptoms during the initial stage of detoxification (specifically Subutex)
These medications should be used as part of a comprehensive treatment plan that includes counseling and psychosocial support. It's important to note that while both drugs contain buprenorphine, a medicine that reduces cravings for opioids, Suboxone also contains naloxone to prevent misuse by injection.
How does Suboxone help with these illnesses?
Suboxone is often used in the management of opioid dependence by reducing cravings and withdrawal symptoms. It contains two active ingredients: buprenorphine, a partial opioid agonist that works by binding to the same receptors in the brain as other opioids, but with less intensity; and naloxone, an opioid antagonist designed to deter misuse by blocking the effects of opioids if Suboxone is injected rather than taken sublingually as intended. The pairing of these two components helps patients manage their condition while also discouraging potential abuse.
On the other hand, Subutex only contains buprenorphine without naloxone's protective properties against misuse. Therefore, while both medications can help individuals cope with addiction and withdrawal symptoms from opioids like heroin or prescription painkillers, Suboxone offers an added layer of protection against misuse which makes it often preferred in long-term management strategies for combating opioid dependency.
What is Subutex?
Subutex is a brand name for buprenorphine, which is an opioid medication used to treat opioid addiction in higher dosages, control moderate acute pain in non-opioid-tolerant individuals in lower dosages and control moderate chronic pain in even smaller doses. It increases the levels of dopamine by reducing its reabsorption, similar to how Wellbutrin operates on norepinephrine and dopamine. This mechanism provides relief from withdrawal symptoms associated with opioid addiction. Buprenorphine was first approved by the FDA in 1981.
As buprenorphine is not an antagonist like naloxone (found within Suboxone), it does not bind to receptors that block the effects of opioids. Its lack of antagonistic action means that its side-effect profile can be different from those medications containing naloxone such as Suboxone -- particularly regarding precipitated withdrawals if taken too soon after using other opioids. The effects on dopamine can be beneficial for treatment of opioid dependency, especially for patients who do not respond well or have adverse reactions to combination drugs like Suboxone.
What conditions is Subutex approved to treat?
Subutex is a medication that has been approved for the treatment of opioid addiction. Its primary uses include:
- Treatment of opioid dependence
- Detoxification in individuals dependent on opioids
It should be noted that Subutex is usually used as part of a complete treatment program including counselling and psychosocial support.
How does Subutex help with these illnesses?
Buprenorphine is a partial opioid agonist that plays key roles in alleviating withdrawal symptoms and reducing cravings associated with opiate addiction. Subutex works by binding to the same receptors in the brain as other opioids, thereby mitigating the impact of withdrawal while also suppressing the euphoria or high feeling typically achieved through opiate use. Its action on mu-opioid receptors may be significant in helping patients transition away from more potent opioids such as heroin or prescription painkillers. Unlike Suboxone, which includes naloxone to deter misuse, Subutex consists solely of buprenorphine and can therefore be preferred during initial stages of treatment for opioid dependence under close medical supervision due to its potential for abuse if not properly managed.
How effective are both Suboxone and Subutex?
Both buprenorphine/naloxone (Suboxone) and buprenorphine alone (Subutex) have been proven effective in treating opioid dependence, having received FDA approval within a year of each other. Both medications work by binding to the same types of receptors in the brain as opioids do, hence reducing cravings and withdrawal symptoms. A 2003 study directly compared Suboxone and Subutex for managing opioid dependency; results showed similar efficacy between both drugs with comparable safety profiles.
A review published in 2016 analyzed multiple studies on the use of these medications. It indicated that buprenorphine is an effective treatment from day one, has manageable side effects compared to many other treatments for opioid addiction, and is well-tolerated even among elderly populations or those with liver impairment. The report also stated that Subutex had become the most widely prescribed medication-assisted treatment for opioid addiction globally due to its effectiveness.
However, it's essential to note that while they are closely related, there are key differences between these two medicines which can affect their utilization depending on individual circumstances. For instance, Suboxone contains naloxone - an antagonist used to prevent abuse by blocking euphoric effects if injected intravenously – whereas Subutex does not contain this component making it easier for misuse through injection but might be preferred during pregnancy due to lack of naloxone.
Nonetheless, like other treatments options available today data supporting standalone use of either drug remains limited compared with combination therapies involving counseling or behavioral therapy interventions.
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At what dose is Suboxone typically prescribed?
Oral dosages of Suboxone range from 2/0.5 mg to 24/6 mg per day, but studies have indicated that a dose of 16/4mg per day is usually sufficient for treating opioid dependence in most people. Adolescents aged over 16 years may be started on lower doses such as 2/0.5 mg or 4/1mg per day. In either population, dosage can be increased after a few days if there is no response and depending on the patient's need without exceeding the maximum daily dose of 24/6mg.
On the other hand, Subutex which contains only buprenorphine (compared to both buprenorphine and naloxone in Suboxone) comes with different recommendations for its use due to lack of naloxone component: adults are typically started at a low dose around between 8-12 mg/day under medical supervision and it could be adjusted based upon individual patient requirement without exceeding the maximum recommended daily dosage limit which is generally accepted as up to around approximately ~32 mg/day.
At what dose is Subutex typically prescribed?
Subutex treatment typically starts with a dosage of 2–4 mg/day taken under the tongue. The dose can then be increased to 8-24 mg/day, divided into two doses, spaced approximately 12 hours apart. Maximum dose is usually around 24 mg/day (although higher doses may sometimes be used), which are divided into two or three sublingual tablets and spaced evenly throughout the day. This maximum dosage might be tested if there is no response to treatment at the lower dosages after a few weeks. As always, all changes in medication schedules should take place under close medical supervision.
What are the most common side effects for Suboxone?
Common side effects of Suboxone, in comparison to Subutex, can include:
- Anxiety and nervousness
- Insomnia or other sleep disturbances
- Fatigue and general weakness (asthenia)
- Headache
- Sweating
- Nausea and vomiting
- Constipation
- Opioid withdrawal syndrome (experiencing symptoms of opioid withdrawal due to the naloxone component)
- Painful tongue if not dissolved properly under your tongue.
Additionally, like many medications used for managing opioid dependency, it may cause decreases in libido. It's essential to monitor these symptoms with a healthcare provider since some might indicate more serious problems.
Are there any potential serious side effects for Suboxone?
Suboxone and Subutex are both used in the treatment of opioid addiction, but they can sometimes cause serious side effects. These might include:
- Severe withdrawal symptoms such as body aches, diarrhea, increased heart rate (tachycardia), fever, sweating excessively
- Signs of an allergic reaction like hives; difficulty breathing; swelling of your face or throat
- Distorted vision or blurred eyesight
- Liver problems: yellowing eyes/skin (jaundice), dark urine, stomach/abdominal pain that doesn't go away, persistent nausea/vomiting
- Respiratory issues: shallow breathing during sleep(apnea), slow irregular breaths which may lead to passing out
- Low blood pressure - this could make you feel dizzy if you get up too fast from sitting or lying position.
If you experience any severe side effects mentioned above after taking Suboxone or Subutex it's crucial to seek immediate medical attention. It is also important to remember not to discontinue these medications abruptly without consulting with your doctor due to risk of severe withdrawal symptoms.
What are the most common side effects for Subutex?
When taking Subutex, the following side effects might be experienced:
- Constipation
- Nausea and vomiting
- Headaches or migraines
- Sweating excessively
- Insomnia or other sleep-related issues
- Mild skin rash
- Anxiety, mood swings, depression
- Increased blood pressure leading to a faster heartbeat
- Respiratory problems such as shortness of breath or wheezing.
Remember that everyone's body reacts differently to medication. While these are some possible side effects of Subutex, they may not occur in every individual taking the drug. Always consult with your healthcare provider when starting any new medication.
Are there any potential serious side effects for Subutex?
While Subutex is generally well-tolerated, it can cause serious side effects in some cases. Such reactions might include:
- Signs of an allergic reaction: hives, difficulty breathing, swelling of your face, lips, tongue or throat
- Symptoms of opioid withdrawal: shivering, increased sweating, goosebumps, runny nose and diarrhea
- Breathing problems; slow breaths or long pauses between breaths
- Light-headedness or feelings faint
- Unusual thoughts or behavior that are not typical for you such as confusion and hallucinations
- Liver problems which may present as upper stomach pain, loss of appetite leading to sudden weight loss and jaundice (yellowing of the skin or eyes)
If any of these symptoms arise while taking Subutex it's important to discontinue use immediately and consult with a healthcare professional.
Contraindications for Suboxone and Subutex?
Both Suboxone and Subutex, as with other medications used to treat opioid addiction, could potentially exacerbate withdrawal symptoms in some individuals. If you notice an intensification of your withdrawal symptoms or if you experience severe dizziness, mental/mood changes (such as agitation, confusion, hallucinations), stomach/abdominal pain, or difficulty urinating while on these medications, seek immediate medical attention.
Neither Suboxone nor Subutex should be taken if you are using or have recently used certain narcotic drugs such as methadone or other buprenorphine-containing products (like Buprenex) due to risk of precipitated withdrawal. It's crucial that your doctor is aware of all the substances you're currently taking; certain narcotics need a specific time frame to clear from your system before starting treatment with either Suboxone or Subutex to avoid harmful interactions.
How much do Suboxone and Subutex cost?
For the brand name versions of these drugs:
- The price for a month's supply of Suboxone (buprenorphine/naloxone) film strips can range from $130 to over $500, depending on the dosage. This equates to approximately $4–17 per day.
- The cost for 30 tablets of Subutex (buprenorphine) averages around $90–200, which works out to about $3-$7/day.
Thus, if you are in the higher dosage range for both medications, then brand-name Subutex may be less expensive on a per-day treatment basis. However, it is important to remember that cost should not be a primary consideration in determining which medication is right for you.
The generic version of buprenorphine costs significantly less:
- Generic buprenorphine typically costs between $.50 and $1.75 per tablet.
Please note that prices vary widely based on location and pharmacy choice. It's also critical to consider your insurance coverage when evaluating potential drug costs.
Popularity of Suboxone and Subutex
Suboxone, a combination of buprenorphine and naloxone, was estimated to have been prescribed to approximately 3 million people in the US in 2020. Suboxone accounted for just over 60% of medication-assisted treatment (MAT) prescriptions for opioid use disorder in the US. It has been steadily increasing in prevalence since its approval by the FDA in 2002.
On the other hand, Subutex, which contains only buprenorphine, was prescribed to fewer patients during that same period. In fact, it's no longer available as a branded product; generic versions are used instead. In comparison with Suboxone's market share among MAT prescriptions, buprenorphine-only formulations like those found in former brand-name drug Subutex represent under 10%. This is largely due to concerns about misuse or diversion associated with this formulation when compared with combination products like Suboxone.
Conclusion
Both Suboxone (buprenorphine and naloxone) and Subutex (buprenorphine) are extensively used in the treatment of opioid addiction, with numerous studies supporting their effectiveness compared to placebo treatments. In certain cases, these drugs may be utilized together under careful physician monitoring as they can interact with each other. Because of their distinct composition, with Suboxone containing both an opioid agonist (buprenorphine) and an antagonist (naloxone), while Subutex contains only buprenorphine, they are typically prescribed in different scenarios.
Subutex is often employed as a first-line treatment during the initial stages of opioid dependence therapy due to its lower risk for misuse; whereas Suboxone is commonly used for maintenance therapy because it has less potential for abuse owing to the presence of naloxone which prevents euphoric effects if injected.
These medications are available in generic forms offering significant cost savings especially for patients paying out-of-pocket. Both medications may require some time before noticeable effects on cravings and withdrawal symptoms occur.
The side effect profiles between these two medications differ slightly but generally well-tolerated – common side effects include constipation, headache, nausea, sweating among others. However, unlike Wellbutrin's advantage over Prozac regarding sexual dysfunction and weight gain issues mentioned previously; neither medication holds a similar clear-cut advantage over another when comparing Subutex versus Suboxon. For both drugs though patients must closely monitor any severe symptoms like trouble breathing or signs of serious allergic reactions such as rash or swelling and should seek immediate medical help if such conditions arise.
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Refrences
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