Is Suboxone (buprenorphine/naloxone) used to treat panic attacks?

Suboxone is NOT Indicated for Panic Attacks

Suboxone (buprenorphine/naloxone) is not indicated for the treatment of panic attacks and should not be used for this purpose. Suboxone is specifically approved and indicated for the treatment of opioid use disorder, not anxiety disorders 1.

Appropriate Treatments for Panic Attacks

The first-line pharmacological treatments for panic disorder include:

1. Selective Serotonin Reuptake Inhibitors (SSRIs) - These are the recommended first-line medication treatment for panic disorder 2, 3

   • Examples include paroxetine, fluoxetine, sertraline, and citalopram
   • SSRIs have strong evidence for efficacy and better tolerability than some alternatives

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) - Particularly venlafaxine has shown efficacy 3

3. Benzodiazepines - May be used for short-term management of acute symptoms 2, 4

   • Examples include alprazolam, clonazepam, and diazepam
   • Should be reserved for short-term use due to risk of dependence
   • May be combined with SSRIs in the first weeks of treatment before the SSRI takes effect

4. Cognitive Behavioral Therapy (CBT) - The psychological treatment of first choice for panic disorder 2

Why Suboxone is Not Appropriate for Panic Attacks

Suboxone contains buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. This medication is specifically designed for medication-assisted treatment of opioid use disorder 1:

• Buprenorphine binds to opioid receptors to reduce cravings and withdrawal symptoms in patients with opioid dependence
• The naloxone component is included to prevent misuse by injection
• There is no evidence supporting its use for anxiety disorders or panic attacks
• Using Suboxone for panic attacks would be an inappropriate off-label use with potential risks

Potential Harms of Misusing Suboxone for Panic Attacks

Using Suboxone for panic attacks could lead to:

• Development of physical dependence on opioids
• Risk of respiratory depression (though less than with full opioid agonists due to buprenorphine's ceiling effect)
• Withdrawal symptoms if discontinued
• Potential for misuse and diversion
• Delayed appropriate treatment with evidence-based therapies

Proper Clinical Approach for Panic Attacks

For patients presenting with panic attacks, the appropriate clinical approach includes:

1. Diagnosis: Confirm panic disorder diagnosis using DSM-5 criteria and rule out medical causes of symptoms

2. First-line pharmacotherapy:

   • Start with an SSRI (paroxetine or fluoxetine have strong evidence) 2, 3
   • Consider short-term benzodiazepine use for immediate symptom relief while waiting for SSRI effect

3. Psychotherapy: Refer for cognitive behavioral therapy, which has strong evidence for efficacy 2

4. Monitoring: Regular follow-up to assess response, side effects, and need for treatment adjustments

Conclusion

Suboxone is exclusively indicated for opioid use disorder treatment and has no role in treating panic attacks or anxiety disorders. Using medications for their approved indications is essential for patient safety and effective treatment. Patients with panic attacks should be treated with evidence-based approaches including SSRIs, SNRIs, appropriate short-term use of benzodiazepines, and cognitive behavioral therapy.