Suboxone is a combination opioid medication that is mainly used in the management of opioid dependence. It is made of two different types of opioids: buprenorphine, which is a partial opioid agonist, and naloxone, which is an opioid antagonist. [1]
Combining these two opioids can help reduce the symptoms of withdrawal and craving in people suffering from opioid addiction. Although it has been found to be effective for medication-assisted treatment (MAT), it is important to know that Suboxone may also lead to side effects.
How Does Suboxone Work?
In order to properly understand the side effects of suboxone, it is helpful to first know how this medication works. Buprenorphine binds to the opioid receptors within the brain, and activates these receptors to reduce cravings and withdrawal. On the other hand, naloxone blocks opioid receptors and discourages the misuse of opioids. [2] This dual mechanism helps ease symptoms of addiction without producing the euphoric sensation of opioids.
Common Suboxone Side Effects
If taken as prescribed, most people tolerate Suboxone well. However, like all medications, Suboxone may also lead to certain side effects. [3] These effects may be especially evident during the initial adjustment phase.
Headache
One of the most common side effects of Suboxone is headache. It is usually mild but on rare occasions, it may be persistent enough to interfere with daily life.
Nausea and Vomiting
Buprenorphine may affect the gastrointestinal system. Therefore, some people may experience nausea, upset stomach, or vomiting.
Constipation
Like other opioids, Suboxone may slow down bowel movements, which may be why constipation is a commonly reported complaint among long-term users.
Drowsiness or Fatigue
Some people experience tiredness or difficulty concentrating. These symptoms usually improve over time as the body adjusts.
Dry Mouth
Decreased saliva production can make your mouth feel dry or sticky. Additionally, if dry mouth is not managed, it also increases the risk of dental problems.
Sweating
In some Suboxone users, excessive sweating, especially night sweats, can be a bothersome side effect.
Insomnia
Sleep disturbances, including difficulty falling or staying asleep, have also been reported in the early weeks of treatment.
What Are the Worst Side Effects of Suboxone?
Most side effects of Suboxone are mild. But there are some serious or potentially dangerous side effects that require immediate medical attention. [3]
Respiratory Depression
While rare, high doses of buprenorphine, especially when mixed with other sedatives, may slow or even completely stop breathing. This is a medical emergency that needs to be urgently treated.
Liver Problems
Suboxone may cause drug-induced liver injury, which may manifest in the form of raised liver enzymes or liver injury in some people. Symptoms that suggest liver injury are yellowing of the skin or eyes, dark urine, or upper right abdominal pain.
Allergic Reactions
Rarely, some people taking Suboxone may develop severe allergic reactions such as hives, swelling of the face or throat, and they may even have difficulty breathing.
Dependency and Withdrawal
Despite its role in treating opioid use disorder, Suboxone itself may cause physical dependence. If you suddenly stopped taking this medication, you may develop withdrawal symptoms such as anxiety, muscle aches, and nausea.
Hormonal Effects
With long-term use, Suboxone may impact testosterone levels. This may reduce libido and cause mood swings in some people.
Long-Term Side Effects of Suboxone
Taking Suboxone for months or years may have long-term adverse effects:
- Dental Issues: The FDA has issued warnings about serious dental problems, such as tooth decay and infections with sublingual Suboxone.
- Hormonal Imbalance: Chronic intake of Suboxone may disrupt levels of cortisol and sex hormone.
- Tolerance or Diminished Effect: Although rare, some people find Suboxone to be less effective over time.
Mental and Emotional Side Effects
There have been reports of psychological or cognitive changes, such as:
- Anxiety
- Depression
- Irritability
- Mood instability
- Brain fog or difficulty focusing
These symptoms may occur due to the effects of the drug itself or from the psychological adjustment to a life without full opioids.
Risk Factors: Who Is More Likely to Experience Suboxone Side Effects?
People with preexisting medical conditions may be more prone to side effects. Therefore, it is important to disclose your full medical history before starting Suboxone. Some conditions that may increase the risk of side effects include
- Liver disease
- Respiratory conditions like asthma or COPD
- Those taking benzodiazepines or alcohol
- People with a history of allergic reactions to opioids
How to Manage Suboxone Side Effects
Most side effects usually resolve on their own. But severe or persistent side effects requires medical intervention. Some ways to manage side effects include:
Start Low, Go Slow
Start with the lowest effective dose to minimize the risk of side effects. Gradually adjusting the dose gives your body time to adapt.
Stay Hydrated and Eat Well
Nausea and constipation can be managed with adequate hydration, a fiber-rich diet, and regular meals.
Practice Oral Hygiene
After taking Suboxone, you need to rinse your mouth and maintain regular dental checkups in order to prevent tooth decay.
Talk to Your Doctor
If the side effects are severe or persistent, you should consult with your prescribing doctor. They may adjust your dose, switch medications, or prescribe other supportive treatments.
Don’t Stop Suddenly
Suboxone should never be stopped abruptly without medical guidance. By following a tapering schedule, you can reduce the risk of withdrawal.
When to Seek Emergency Help
Call the emergency hotline or go to the ER if you or someone else on Suboxone experiences:
- Difficulty breathing
- Loss of consciousness
- Severe allergic reaction
- Chest pain or palpitations
- Suicidal thoughts or behaviors
These may signal life-threatening complications.
Final Thoughts: Weighing the Benefits vs. Side Effects
Suboxone has helped countless people recover from opioid addiction. In rare cases, the side effects of Suboxone can be bothersome or even serious. However, they are often manageable with medical supervision and support.
If you’re considering Suboxone or are currently using it, it is important not to ignore unusual symptoms and contact your health provider immediately.
References
| ↑1 | Velander, Jennifer R. “Suboxone: rationale, science, misconceptions.” Ochsner Journal 18.1 (2018): 23-29 |
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| ↑2 | Nickson, Chris. “Suboxone poisoning.” |
| ↑3 | Strickland, D. M., and J. K. Burson. “Sublingual absorption of naloxone in a large clinical population.” J Drug Metab Toxicol 9.02 (2018): 240 |