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Opioid Partial Agonist — Opioid Substitution Therapy (OST)

Buprenorphine / Naloxone (Sublingual)

Brand names: Suboxone, Espranor

This is the sublingual fixed combination of buprenorphine with naloxone, used as substitution treatment for opioid dependence within a supervised drug-treatment service.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Buprenorphine is a partial mu-opioid agonist that controls withdrawal and craving; the added naloxone (an opioid antagonist) has poor sublingual absorption but precipitates withdrawal if the product is misused by injection, deterring diversion.

Prescribing in practice

  • Like buprenorphine alone, the first dose must wait until objective withdrawal has begun, as the partial agonist can otherwise precipitate withdrawal.
  • Co-use with benzodiazepines, alcohol or other CNS depressants markedly increases the risk of fatal respiratory depression.
  • The naloxone component is intended to discourage intravenous misuse but does not remove the need for supervised consumption and confirmation of dependence.

Monitoring

Monitor withdrawal and craving control, sedation, ongoing substance misuse and diversion, with liver function checks where clinically indicated.

Counselling the patient

  • Take this only when you are already in withdrawal, otherwise it can bring on withdrawal quickly.
  • Injecting this preparation will trigger withdrawal because of the naloxone in it.
  • Avoid alcohol and sedative medicines, which can dangerously slow your breathing.

Evidence & guidelines

NICE recommends buprenorphine (including buprenorphine/naloxone) or methadone for opioid substitution within structured treatment services.

Reference: NICE NG58 (Opioid Dependence); UK Drug Misuse and Dependence Guidelines 2017; MHRA Drug Safety Update 2018 (benzodiazepine interactions); Kakko et al. Lancet 2003; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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