Restarting Suboxone After a Missed Dose
Yes, you can restart Suboxone now and give the next dose at 2100, then resume the regular 0900 and 2100 schedule tomorrow. 1
Immediate Dosing Strategy
- Give the full prescribed dose now to re-establish therapeutic levels and prevent withdrawal symptoms 2
- Administer the evening dose at 2100 as scheduled to maintain steady-state buprenorphine levels 2
- Resume the regular twice-daily schedule (0900 and 2100) starting tomorrow without any dose adjustments needed 1
Key Pharmacological Considerations
Buprenorphine has a long half-life and high receptor affinity, which provides flexibility in dosing schedules even after missed doses 3:
- The medication's slow dissociation from mu-opioid receptors means a single missed dose is unlikely to cause significant withdrawal 3
- Patients maintained on buprenorphine can tolerate dosing irregularities better than those on short-acting full agonists 2
- The long duration of action (24-72 hours) provides a buffer against withdrawal even with delayed dosing 4
Critical Safety Points
Do NOT wait for withdrawal symptoms before restarting in a patient already established on Suboxone maintenance therapy 1:
- The requirement for mild withdrawal (COWS 8-12) only applies when initiating buprenorphine in someone taking full opioid agonists 2, 1
- For patients already on stable Suboxone therapy who miss a dose, simply resume the regular dose immediately 2
- Waiting unnecessarily risks precipitating withdrawal and treatment dropout 2
Common Pitfall to Avoid
The most important mistake to avoid is confusing buprenorphine induction protocols with maintenance dosing 2, 1:
- Induction requires waiting for withdrawal to prevent precipitated withdrawal when switching FROM full agonists 5, 6
- Maintenance therapy continuation or restart after brief interruption does NOT require withdrawal symptoms 2, 1
- Missing one or two doses in an established patient does not reset the need for formal induction 2