Suboxone and Double Vision
Suboxone (buprenorphine/naloxone) is not documented to cause double vision as a recognized adverse effect in the medical literature or clinical guidelines. The available evidence from major guidelines and research studies does not identify diplopia (double vision) as a known side effect of this medication.
Evidence Review
The comprehensive guidelines and research on buprenorphine/naloxone treatment for opioid use disorder do not list double vision among the documented adverse effects:
Safety profile documentation: Multiple systematic reviews confirm that buprenorphine demonstrates a favorable safety profile with fewer adverse events compared to full opioid agonists, but double vision is not mentioned among these effects 1, 2.
Known adverse effects: The documented side effects of buprenorphine/naloxone include withdrawal symptoms when parenterally administered in opioid-dependent patients, potential for diversion and misuse, and general opioid-related effects, but not visual disturbances like diplopia 3, 2.
Drug interactions: While buprenorphine has important drug-drug interactions that can result in QT-interval prolongation, serotonin syndrome, paralytic ileus, reduced analgesic effect, or precipitation of withdrawal symptoms, visual disturbances are not highlighted 4.
Clinical Considerations
If a patient on Suboxone reports double vision, consider:
Alternative causes: Evaluate for other medications the patient may be taking, particularly benzodiazepines or other CNS depressants that commonly cause diplopia.
Substance use: Screen for concurrent use of other substances that could cause visual disturbances.
Neurological evaluation: Double vision warrants assessment for underlying neurological conditions unrelated to Suboxone.
Psychiatric symptoms: In rare cases, abrupt discontinuation of buprenorphine has been associated with new-onset psychotic symptoms, though this involves discontinuation rather than ongoing use 5.
The absence of double vision in the extensive literature on buprenorphine treatment 6, 7, 3, 2, 8 strongly suggests this is not a medication-related effect.