Understanding Suboxone Side Effects: A Complete Guide

In moderate to severe cases of opioid dependence, medication-assisted treatment can significantly improve comfort levels and health outcomes. Suboxone stands as one of the most effective options available today.

However, like all medications, Suboxone comes with a range of possible side effects. Understanding these effects, including the circumstances that make them more or less likely to occur, is an important piece of each patient’s research and reflection as they walk through their recovery journey.

Understanding how Suboxone works, potential side effects, and how you can best manage them offers a greater chance of a smooth and safe recovery experience.

What Is Suboxone?

Initially approved by the Food and Drug Administration (FDA) in 2002 for opioid dependence, suboxone is a powerful tool when wielded properly.[1] This drug reduces opioid withdrawal symptoms, cravings, and even the effects of opiate medications after they are consumed.

Suboxone is a combination medication containing two active ingredients: buprenorphine and naloxone. Each active ingredient takes a different approach to interfering with cravings and other common issues involved with opioid use disorder.

Buprenorphine: Mechanism and Effects

Taking an opioid to reduce opioid dependence may seem contradictory, but buprenorphine’s effects on certain opioid receptors render it an appropriate choice for those in recovery.

Specifically, buprenorphine is a long-acting opioid that binds to “mu receptors” in such a way that suppresses opioid withdrawal symptoms.[2] Buprenorphine’s actions at these receptors also block the ability of abused opioids to create euphoric effects.[3]

Outside of its actions on mu receptors, buprenorphine is an antagonist at other opioid receptors (kappa and delta), meaning it can “plug up the receptor” in a similar way without powerfully activating it like a recreationally used drug would.[4]

How Naloxone Decreases the Effects of Opioids

Naloxone is a classic opioid antagonist, meaning it competes against opioids across various receptors to significantly decrease their uptake.[5] Though naloxone binds to opioid receptors, it does not produce euphoria.

When combined with buprenorphine, naloxone forms an effective defense against opioids.

Common Suboxone Side Effects

Though Suboxone is generally well-tolerated when used as directed, many patients experience one or more common side effects when first starting a Suboxone treatment program.

Understanding what to expect can help reduce anxiety about your medication regimen.

Physical Suboxone Side Effects

Suboxone has been associated with the following physical side effects:[6]

• Constipation affects up to 40% of patients taking Suboxone. This digestive issue can range from mild to severe discomfort.
• Nausea and vomiting sometimes occur, especially during the first week of treatment. These symptoms usually improve as your body adjusts.
• Headaches affect some patients initially. They typically decrease in frequency and intensity over time.
• Sleep disturbances, including insomnia or excessive drowsiness, may occur. Sleep patterns often normalize within a few weeks.
• Sweating and hot flashes can be bothersome. These effects usually diminish as treatment continues.

Neurological Suboxone Side Effects

Due to its interactions with the central nervous system (CNS), Suboxone can cause several neurological side effects (some more common than others). These neurological side effects include, but are not limited to, the following:[7]

• Dizziness and lightheadedness affect some patients. These symptoms can impact daily activities initially.
• Cognitive fog or difficulty concentrating may occur. Mental clarity typically improves as treatment progresses.
• Mood changes, including irritability or anxiety, can occur. These effects often stabilize within the first month.
• Sleepiness is a less common, but not completely unheard of, side effect of Suboxone use.
• Conversely, insomnia is reported more frequently among those who use Suboxone.

Gastrointestinal Suboxone Side Effects

Finally, Suboxone may cause concerns within the digestive system as well. The gastrointestinal side effects of Suboxone include:[8]

• Stomach pain and digestive discomfort affect some patients. Taking Suboxone with food can help reduce these symptoms.
• Loss of appetite may occur initially. Appetite usually returns to normal patterns over time.
• Dry mouth is a common complaint. Staying hydrated and using sugar-free gum can provide relief.

Serious Suboxone Side Effects to Watch For

While most side effects of Suboxone are manageable without immediate medical attention, it’s vital that you know what to look for and how to respond when more serious side effects occur.

A rare, but potentially severe side effect of suboxone is respiratory depression.[9] This refers to a series of changes that negatively impact breathing. Central nervous system (CNS) depressants are common culprits, causing slow and shallow breaths. In severe cases, you can even forget to breathe.

It can sometimes be difficult to detect shallow breathing when monitoring someone else for Suboxone side effects. Blue lips or fingernails are two more signs that the body is not receiving enough oxygen.

Allergic Reactions

Severe allergic reactions are highly uncommon among those who have followed the proper channels (medical diagnosis and prescription, etc.), but still possible.

If you notice a rash, swelling, or difficulty breathing after taking Suboxone, stop taking it immediately and seek immediate care. A severe allergic reaction to Suboxone may cause anaphylaxis, a potentially life-threatening problem associated with breathing difficulties and sharp blood pressure drops.[10]

Liver Problems

Hepatotoxicity and hepatitis can occur in rare cases.[11] Regular liver function monitoring is essential during treatment.

Warning signs include yellowing of skin or eyes, dark urine, and severe abdominal pain.

Long-Term Suboxone Side Effects

Even when taken as advised, extended use of Suboxone may increase the risk of certain health concerns. These include hormonal changes, dental health issues, and the possibility of physical dependence.

Hormonal Changes

Opioid-induced endocrine disruption, including adrenal insufficiency, has been associated with long-term Suboxone use.[12] This problem leaves patients predisposed to “high-mortality adrenal crises,” as the above study phrased it.

Regular monitoring of hormone levels (including testosterone, cortisol, and others) may be advised during long-term treatment.

Dental Health Concerns

Tooth decay has been correlated with Suboxone use.[13] It is thought that the acidity level of the medication contributes to the wearing down of enamel.

Dependency Considerations

Physical dependence develops with regular Suboxone use, though it is significantly less likely than with most other opioids.[14] This is different from addiction and represents normal physiological adaptation.

Medical supervision is key when making the decision to cease Suboxone use, as quitting cold turkey can cause serious withdrawal symptoms.

Discontinuation should always occur under medical supervision to prevent withdrawal symptoms.

When to Contact a Healthcare Professional

Every patient carries a unique set of circumstances and risk factors. Your prescribing physician will provide you with individualized instructions regarding the best course of action to take if certain Suboxone side effects occur.

Some Suboxone side effects will resolve on their own, while others require a quick response, including medical treatment and adjustments to your medication plan.

Generally, patients are advised to contact their providers if they have any trouble breathing, chest pain, or signs of an allergic reaction.

Always be highly transparent with your prescribing provider when discussing Suboxone use, even if the side effects you may be experiencing are mild or fleeting.

Reach Out for Help Today

Recovering from substance abuse is a collaborative effort that requires both the patient and the care team to be open and honest throughout the process. This includes acknowledging you have a problem in the first place and reaching out for help.

If you are even slightly concerned that you may have an opioid problem, or if you’re experiencing any issues with Suboxone use, reaching out to a professional detox and rehabilitation center may make the difference between a successful recovery and months or years of continued struggle.

Remember, experiencing side effects doesn’t necessarily mean that the Suboxone isn’t working. With proper management and support, you can overcome these challenges, including your opioid dependence.

Your recovery journey deserves professional-grade care in a compassionate and understanding environment. Take the first step toward getting the help you need today.