How soon can you take Suboxone (buprenorphine) after stopping naltrexone?

Timing of Suboxone Initiation After Naltrexone Discontinuation

You should wait 2-3 days after stopping oral naltrexone before initiating Suboxone (buprenorphine), or 24-30 days after the last extended-release naltrexone injection. 1

Oral Naltrexone Washout Period

The critical waiting period is determined by naltrexone's pharmacology and its active metabolite:

• Naltrexone has a plasma half-life of 4 hours, but its active metabolite (6-β-naltrexol) has a half-life of 13 hours 1, 2
• The metabolite accumulates during long-term therapy, and antagonist effects persist for 2-3 days after stopping oral naltrexone 1, 2
• This 2-3 day washout period allows sufficient clearance of both naltrexone and its active metabolite to prevent precipitated withdrawal when buprenorphine is introduced 1

Extended-Release Naltrexone Considerations

If the patient was on extended-release naltrexone (Vivitrol injection):

• A much longer washout period of 24-30 days after the last injection is required before starting buprenorphine 1, 2
• This extended timeframe accounts for the depot formulation's prolonged release and receptor occupancy 1

Critical Clinical Pitfalls

Starting buprenorphine too early after naltrexone can precipitate severe withdrawal because:

• Naltrexone blocks opioid receptors as a competitive antagonist 1
• Buprenorphine, as a partial agonist, requires available opioid receptors to bind effectively 1
• Attempting to initiate buprenorphine while naltrexone still occupies receptors can trigger acute withdrawal symptoms 1

Verification Before Buprenorphine Induction

Before starting Suboxone after the appropriate washout period:

• Confirm the patient is experiencing at least mild opioid withdrawal symptoms using a validated opioid withdrawal scale 1
• The presence of withdrawal symptoms indicates sufficient receptor availability for buprenorphine binding 1
• Recheck withdrawal symptoms 30 minutes after the initial buprenorphine dose to ensure tolerance 1

Practical Algorithm

1. Determine naltrexone formulation: oral (2-3 days) vs. extended-release (24-30 days) 1
2. Wait the appropriate washout period based on formulation 1, 2
3. Assess for mild withdrawal symptoms using a validated scale before buprenorphine administration 1
4. Initiate buprenorphine only after confirming withdrawal symptoms to prevent precipitated withdrawal 1
5. Monitor closely for 30 minutes after initial dose and adjust accordingly 1