Administration Directions for Suboxone Sublingual Tablets
Suboxone sublingual tablets must be placed under the tongue and held there until completely dissolved—patients should not eat, drink, chew, cut, or swallow the tablets. 1
Proper Administration Technique
Tablet Placement
- Place tablets under the tongue until they dissolve completely
- For doses requiring more than 2 tablets, patients have two options:
- Place all tablets under the tongue at once, OR
- Place 2 tablets at a time under the tongue if more cannot fit comfortably
- Continue holding tablets under the tongue until fully dissolved—swallowing reduces bioavailability 1, 2
- Do not eat or drink until the tablet is completely dissolved 2
Consistency is Critical
Patients must follow the same administration method consistently to ensure consistent bioavailability with continued use 1, 2. Proper administration technique should be demonstrated to the patient at initiation 2.
Dosing Schedule
Induction Phase
- Use buprenorphine monoproduct (Subutex) for induction, not Suboxone, as it contains no naloxone 1
- Only administer when objective signs of moderate opioid withdrawal are present to avoid precipitated withdrawal 3, 2
Typical induction protocol:
- Day 1: 8 mg buprenorphine
- Day 2: 16 mg buprenorphine
- Day 3 onward: Switch to Suboxone at same dose 1, 2
Maintenance Phase
- Suboxone is preferred for maintenance due to naloxone's deterrent effect against diversion 1, 2
- Target maintenance dose: 16 mg once daily 1, 2
- Effective dose range: 12-24 mg daily (some patients respond to 12 mg) 1
- Adjust in 2-4 mg increments/decrements to suppress withdrawal and retain patient in treatment 1, 2
- Administer as single daily dose 1, 2
Critical Warnings
When NOT to Use Suboxone
- Do not use in patients hypersensitive to naloxone—use buprenorphine monoproduct instead 1, 2
- Avoid concomitant use with QT-prolonging agents (contraindicated) 4
- Monitor for drug interactions causing serotonin syndrome, paralytic ileus, or reduced analgesic effect 4
Precipitated Withdrawal Risk
Because buprenorphine has high mu-receptor affinity and partial agonist properties, administering before adequate withdrawal onset can precipitate severe withdrawal symptoms 3. This risk is particularly high in patients on methadone >30 mg daily 2.
Supervision and Monitoring
- Treatment should begin with supervised administration, progressing to unsupervised as clinical stability permits 2
- Ideally see patients at least weekly during first month 2
- Once stable, monthly visits may be reasonable for patients with negative drug screens and treatment progress 2
- Provision of multiple refills not advised early in treatment without appropriate follow-up 2
Special Considerations
The naloxone component in Suboxone has no clinically significant effect when taken sublingually as prescribed because naloxone is poorly absorbed sublingually (half-life 1 hour vs 32 hours for buprenorphine) 5. However, if parenterally administered in opioid-dependent patients, naloxone causes withdrawal effects, reducing abuse potential 6, 7.