Buprenorphine/naloxone: a review of its use in the treatment of opioid dependence

Drugs. 2009;69(5):577-607. doi: 10.2165/00003495-200969050-00006.

Abstract

Buprenorphine/naloxone (Suboxone) comprises the partial mu-opioid receptor agonist buprenorphine in combination with the opioid antagonist naloxone in a 4 : 1 ratio. When buprenorphine/naloxone is taken sublingually as prescribed, the naloxone exerts no clinically significant effect, leaving the opioid agonist effects of buprenorphine to predominate. However, when buprenorphine/naloxone is parenterally administered in patients physically dependent on full agonist opioids, the opioid antagonism of naloxone causes withdrawal effects, thus reducing the abuse potential of the drug combination. Buprenorphine/naloxone is an effective maintenance therapy for opioid dependence and has generally similar efficacy to methadone, although more data are needed. Less frequent dispensing of buprenorphine/naloxone (e.g. thrice weekly) does not appear to compromise efficacy and can improve patient satisfaction. Buprenorphine/naloxone is more effective than clonidine as a medically-supervised withdrawal therapy. Moreover, buprenorphine/naloxone is a generally well tolerated medically-supervised withdrawal and maintenance treatment. Thus, sublingual buprenorphine/naloxone is a valuable pharmacotherapy for the treatment of opioid dependence.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Buprenorphine / administration & dosage*
  • Buprenorphine / adverse effects
  • Buprenorphine / pharmacokinetics
  • Clinical Trials as Topic
  • Drug Combinations
  • Drug Interactions
  • Humans
  • Methadone / therapeutic use
  • Naloxone / administration & dosage*
  • Naloxone / adverse effects
  • Naloxone / pharmacokinetics
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / adverse effects
  • Narcotic Antagonists / pharmacokinetics
  • Opioid-Related Disorders / rehabilitation*

Substances

  • Drug Combinations
  • Narcotic Antagonists
  • Naloxone
  • Buprenorphine
  • Methadone