Can you crush Subutex (buprenorphine) sublingual tablets?

Crushing Subutex (Buprenorphine) Sublingual Tablets

No, you should not crush Subutex (buprenorphine) sublingual tablets as this violates proper administration instructions and may reduce medication effectiveness. 1

Proper Administration of Buprenorphine Sublingual Tablets

Buprenorphine sublingual tablets are specifically designed to be dissolved under the tongue for optimal absorption and effectiveness. The FDA-approved administration instructions clearly state:

• Put the tablets under your tongue
• Let them dissolve completely
• While tablets are dissolving, do not chew or swallow the tablet because the medicine will not work as well
• Talking while the tablet is dissolving can affect how well the medicine is absorbed 1

Why Crushing Is Problematic

Crushing Subutex tablets presents several potential issues:

1. Altered absorption: While one study suggests bioavailability may not be significantly affected 2, the FDA-approved labeling specifically instructs against altering the tablet form

2. Reduced effectiveness: Crushing may interfere with the intended sublingual absorption mechanism, potentially reducing therapeutic effect

3. Misuse potential: Crushing tablets is associated with diversion and misuse, as it can enable snorting or injection of the medication 3

4. Safety concerns: The FDA label warns against injecting crushed tablets, which "may cause life-threatening infections and other serious health problems" 1

Medication Safety Considerations

The FDA label emphasizes several important safety points:

• Buprenorphine is a controlled substance (CIII) that can be a target for misuse
• Proper administration is essential for therapeutic effect
• Altering the administration method violates proper use instructions 1

Alternative Approaches

If a patient is having difficulty with sublingual administration:

• Ensure proper patient education on correct sublingual administration technique
• Consider switching to Suboxone (buprenorphine/naloxone) formulation if appropriate, which has the added safety feature of naloxone to deter misuse 3
• Discuss with the prescribing physician if a different formulation might be more appropriate

Clinical Implications

Improper administration through crushing could lead to:

• Suboptimal treatment outcomes
• Increased risk of misuse and diversion
• Potential legal and ethical issues for both patient and provider

Conclusion

Based on FDA labeling and clinical guidelines, Subutex sublingual tablets should be used exactly as prescribed - placed under the tongue and allowed to dissolve completely. Crushing the tablets contradicts proper administration instructions and may compromise treatment effectiveness and safety.