Patient Information1. Let Subutex or Suboxone tablets dissolve under your tongue; they are much less effective if swallowed.
2. Take no more than two tablets at a time; otherwise you may swallow them by mistake.
3. Wetting the mouth before placing the tablets under the tongue can help the tablets dissolve faster.
4. Don't smoke for 10 to 15 minutes before you take your medication. Not smoking seems to help the tablets dissolve faster.
5. Be sure to tell your doctor or other health care professional about any discomfort you feel. He or she may be able to give you medication that will help.
6. Before you have any medical or dental treatment that involves anesthesia or pain-relieving medication, be sure to tell your physician or dentist that you are taking buprenorphine. The medications may interfere with one another.
7. Do not drive a car or operate machinery until you are sure you can do it safely.
8. If patients continue to use illicit opioids, they may have difficulty stabilizing on buprenorphine, and that if they take their buprenorphine dose shortly after use of an illicit opioid, they may experience transient withdrawal symptoms.
9. Because of buprenorphine's potential to block the effects of other opioids, it is critical to advise patients to alert other treatment providers (such as dentists and ermergency room personal) that they are taking buprenorphine before undergoing any medical procedure or receiving treatment for injury or illness that involves the use of opioids to control pain.
10. In addition, patients should be cautioned against using buprenorphine in combination with other central nervous system depressants such as alcohol and benzodiazepines. And they should be counseled that the side effects of buprenorphine are similar to those of other opioid agonists; the most common are headache, withdrawal syndrone, nonspecific pain, nausea and constipation. These side-effects are not unexpected, are generally mild and manageable, and often resolve in three weeks. (Mello and Mendelson 1995)
11. Patients need to be made aware that misuse of buprenorphine can have serious results. Just as with methadone (Ernest et al. 2002) injecting buprenophine or using larger doses than those prescribed in combination with benzodiazepines can cause death (Kintz, 2002; Reynaud et al.. 1998; Singh et al. 1992).
12. Patients who have a history of liver disease need to be informed about the need for routine monitoring, as increased liver enzyme levels have been reported during buprenorphine maintenance therapy (Lange et al., 1990; Petry et al.; 2000b).
13. And finally, warn all patients that injecting Subutex may cause liver damage. (Berson et al., 2001a, 2001b).
Thank You.
Science And Practice Perspectives August 2004
Clinical Use of Buprenorphine pp.14-15
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