Does Suboxone Need To Be Taken Under The Tongue?
In our latest question and answer, the pharmacist discusses whether or not Suboxone (Buprenorphine/Naloxone) needs to be taken sublingually (under the tongue).
Does swallowing a Suboxone 8/2 mg sublingual tablet whole instead of melting it under your tongue work equivalently? Specifically, I am wondering if ingesting it this way will still allow the medication to absorb as well as sublingually? Can swallowing the tablet whole and changing the ingestion method alter the results of medication level measurements? I'm having a horrible issue with the taste making me sick is why I am asking.
Suboxone (buprenorphine/naloxone) is a combination product available in tablet or film dosage forms and is used for the treatment of pain or opiate dependence. Both product forms of Suboxone need to be dissolved sublingually (under the tongue) or buccally (in the cheek) and allowed to completely dissolve to be effective. Swallowing the tablet or film prior to complete dissolution will reduce the bioavailability of the drug, potentially reducing the effectiveness of the medication.
Proper Suboxone Administration
Bioavailability refers to the rate and extent of absorption of medication. Both components of Suboxone (buprenorphine and naloxone) have extremely poor bioavailability when taken by mouth and swallowed. Suboxone is unlikely to exhibit any beneficial effect if swallowed as blood levels simply won't reach therapeutic levels.
When Suboxone is taken sublingually (or buccally), the bioavailability of buprenorphine increases and allows the drug to reach therapeutic levels in the body. This is due to sublingual and buccal administration bypassing the stomach and GI tract and allowing the drug to directly enter the bloodstream.
Naloxone bioavailability is poor and inconsequential both when taken orally and sublingually. It is an added component of Suboxone that is intended to prevent abuse of the drug. If Suboxone is injected, naloxone will likely precipitate withdrawal symptoms.
Buprenorphine and naloxone reach similar blood levels with buccal and sublingual administration. Due to this, most individuals can switch between buccal and sublingual routes of administration when on maintenance therapy.
However, in those undergoing induction (i.e. therapy initiation) for opioid dependence, the route of administration should stay consistent to avoid precipitating withdrawal as slight variations in bioavailability can occur between buccal and sublingual administration methods.
Proper administration of Suboxone is extremely important to attain therapeutic levels of the drug in the body. If swallowed, bioavailability is poor which will reduce and likely eliminate the effects of the medication. Suboxone must be placed sublingually or buccally for therapeutic effect.