Difference Between Suboxone and Subutex
The main difference between Suboxone and Subutex is that Suboxone contains both buprenorphine and naloxone, while Subutex contains only buprenorphine; Suboxone is generally preferred for most patients due to its reduced potential for misuse. 1
Key Differences
Active Ingredients
- Subutex: Contains only buprenorphine, a partial opioid agonist
- Suboxone: Contains buprenorphine plus naloxone, an opioid antagonist 2
Abuse Deterrent Properties
- Suboxone includes naloxone specifically to discourage intravenous misuse. If injected, the naloxone component can precipitate withdrawal symptoms, making it less likely to be abused 3
- Subutex lacks this abuse-deterrent feature, making it potentially more susceptible to misuse via injection 2
Clinical Applications
Pregnancy
- Subutex (buprenorphine alone) is recommended for pregnant women according to the American College of Obstetricians and Gynecologists 1
- This recommendation exists because of theoretical risks to the fetus if withdrawal is precipitated by the naloxone component, though limited data do not support this theoretical concern 4
General Treatment
- Suboxone is the preferred formulation for most non-pregnant patients due to its safety features that prevent misuse 1
- Both medications are equally effective in treating opioid use disorder when used as prescribed 2
Clinical Considerations
Dosing and Administration
- Both medications are administered sublingually
- Typical target dose is 16 mg daily (range 4-24 mg based on individual response) 1
- Median disintegration time is similar for both formulations (6-12 minutes) 5
Bioequivalence
- Studies have shown that Suboxone formulations are bioequivalent to equivalent doses of Subutex 5
- When switching from Subutex to Suboxone, most patients can be maintained at the same dose, though some patients on higher doses (>22 mg) may require dose adjustments 6
Side Effects
- When patients are switched from Subutex to Suboxone, approximately 50% report adverse events during the first 4 weeks, decreasing to 26.6% at four months 6
- Despite these adverse events, discontinuation rates due to side effects are relatively low 6
Practical Implications
Prescribing Considerations
- Both medications can be prescribed in office-based settings under DATA 2000 regulations 2
- Patients who would not accept treatment in traditional opiate-maintenance clinics may find office-based buprenorphine treatment more acceptable 2
Risk Management
- Multiple drug-drug interactions with either formulation can result in QT-interval prolongation, serotonin syndrome, paralytic ileus, reduced analgesic effect, or precipitation of withdrawal symptoms 4
- Concomitant use of buprenorphine (either formulation) with QT-prolonging agents is contraindicated 4
Special Populations
- For perioperative management, the prescribed daily dose of buprenorphine (either formulation), indication for treatment, risk of relapse, and expected level of postsurgical pain should guide decision-making 4
Common Pitfalls to Avoid
Incorrect switching: When transferring patients from Subutex to Suboxone, careful planning and discussion should occur to minimize adverse events 6
Overlooking pregnancy status: Using Suboxone instead of Subutex in pregnant women, though recent evidence suggests this theoretical concern may be unfounded 4
Inadequate monitoring: Failing to monitor for side effects, cravings, and withdrawal symptoms, especially when switching between formulations 6
Ignoring potential for misuse: Despite Suboxone's abuse-deterrent properties, both medications still have some potential for misuse and should be prescribed with appropriate monitoring 2