Buprenorphine with naloxone

How it works

The buprenorphine component is a high-affinity partial mu-opioid agonist that relieves withdrawal and craving, while the poorly-absorbed naloxone precipitates withdrawal if the product is injected, acting as an abuse deterrent.

Prescribing in practice

• Start only once objective opioid withdrawal is present, since premature dosing can precipitate withdrawal because of buprenorphine's partial-agonist action.
• Concomitant benzodiazepines, alcohol or other sedatives substantially increase the risk of respiratory depression and death.
• Dependence should be confirmed and early doses supervised; the naloxone deters intravenous misuse but is not a substitute for clinical oversight.

Monitoring

Monitor for control of withdrawal symptoms, sedation, illicit drug use and diversion, with liver function monitoring where indicated.

Counselling the patient

• Wait until you are in withdrawal before your first dose.
• Do not inject this medicine, as it will cause withdrawal.
• Keep it out of reach of children and others, as it is dangerous to people who are not opioid-tolerant.

Evidence & guidelines

NICE supports buprenorphine/naloxone as an option for opioid substitution treatment within a structured recovery-oriented service.