From the FDA Drug Label
Severe Hypotension Buprenorphine hydrochloride may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients
There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume, or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics).
Manifestations of histamine release and/or peripheral vasodilation may include pruritus, flushing, red eyes, sweating, and/or orthostatic hypotension
Buprenorphine hydrochloride may cause a decrease or, rarely, an increase in pulse rate and blood pressure in some patients.
Yes, buprenorphine can cause hypotension, including orthostatic hypotension and syncope, especially in patients with compromised blood volume or those taking certain CNS depressant drugs 1.
From the Research
Suboxone (buprenorphine/naloxone) can cause hypotension as a side effect, particularly in patients who are opioid-naive, dehydrated, elderly, or taking other medications that lower blood pressure. The mechanism involves buprenorphine's action on opioid receptors, which can affect the cardiovascular system by causing peripheral vasodilation 2. Patients taking Suboxone should be monitored for symptoms of hypotension such as dizziness, lightheadedness, or fainting, especially when changing positions quickly. If these symptoms occur, patients should sit or lie down immediately and contact their healthcare provider. Staying well-hydrated and avoiding alcohol or other central nervous system depressants while taking Suboxone can help reduce the risk of hypotension. It is essential to note that the provided evidence does not directly link Suboxone to hypotension; however, the medication's mechanism of action and potential side effects suggest a possible association 2. In clinical practice, it is crucial to prioritize the patient's safety and monitor for potential side effects, especially when initiating or adjusting Suboxone treatment. The most recent and highest quality study available should guide clinical decision-making; however, in this case, the evidence is limited, and a consensus-based approach is necessary 3, 2. In real-life clinical medicine, it is essential to err on the side of caution and carefully monitor patients for signs of hypotension when prescribing Suboxone. Key considerations include:
- Monitoring patients for symptoms of hypotension, such as dizziness or lightheadedness
- Encouraging patients to stay well-hydrated and avoid alcohol or other central nervous system depressants
- Adjusting the dose or treatment plan as needed to minimize the risk of hypotension
- Prioritizing patient safety and taking a cautious approach when initiating or adjusting Suboxone treatment.