How should a patient with opioid use disorder take buprenorphine-naloxone (8-2 mg tablet) to achieve a daily dose of 12 mg?

How to Take Buprenorphine-Naloxone 8-2 mg Tablets for a 12 mg Daily Dose

The patient should take one and a half tablets (1.5 tablets) of buprenorphine-naloxone 8-2 mg once daily to achieve the prescribed 12 mg dose.

Dosing Calculation and Administration

• Each buprenorphine-naloxone 8-2 mg tablet contains 8 mg of buprenorphine (the active opioid component) and 2 mg of naloxone 1
• To achieve 12 mg of buprenorphine daily: 12 mg ÷ 8 mg per tablet = 1.5 tablets 1
• The patient should take 1.5 tablets as a single daily dose, administered sublingually (under the tongue) until completely dissolved 1, 2

Practical Administration Instructions

• The tablets should be placed under the tongue and allowed to dissolve completely, which typically takes 5-10 minutes 1
• Patients should not swallow, chew, or crush the tablets, as sublingual absorption is essential for proper bioavailability 1
• To split a tablet for the half-tablet dose, the patient can use a pill cutter or break along the score line if present 1
• The entire daily dose (1.5 tablets) should be taken at the same time each day to maintain stable blood levels 2

Clinical Context for Opioid Use Disorder Treatment

• Buprenorphine-naloxone maintenance doses typically range from 8-24 mg daily, with 16 mg per day showing clear superiority over placebo 1
• Fixed dosages of at least 7 mg per day are as effective as methadone for treatment retention and decreased opioid use 1
• The 12 mg daily dose falls within the therapeutic range and should be continued as a scheduled daily medication, not on an as-needed basis 3, 2

Important Monitoring Considerations

• Patients should be monitored for withdrawal symptoms, cravings, or continued opioid use, which may indicate the need for dose adjustment 1, 4
• If withdrawal symptoms or cravings persist despite the 12 mg dose, the patient should be promptly evaluated for dose escalation up to 16-24 mg daily 4
• Common adverse effects at this dose include constipation, headache, nausea, drowsiness, and sedation, which are generally well-tolerated 1, 5