Patient Tips for Taking Sublingual Buprenorphine
Remind patients of key points relevant to successful induction covered the day of induction. These include:
- The possibility of taking recommended comfort medications for residual withdrawal symptoms or requesting additional comfort medications as needed
- Taking doses as directed; not taking a dose on their own unless this has been carefully explained and authorized by you
- Reminders of the importance to abstain from the opioid they were using and other substances
Buprenorphine is administered sublingually and must be dissolved under the tongue, not swallowed. Each buprenorphine film or tablet will take some time to dissolve under the tongue and absorb, but the Suboxone® film and the new, smaller Zubsolv®* tablet dissolve more quickly than generic tablets: the mean time for the film to dissolve is 5 to 6.6 minutes; for generic tablets it is 7 to 12.4 minutes, and for Zubsolv® it is a few minutes. The patient should not talk, drink, or swallow during this time. Patients who are maintained on higher doses should take 1-2 films or tablets at a time rather than all together. Some patients may also find the following helpful:
- Eating a mint or having a drink of water right before taking the tablet helps the tablet to dissolve more easily.
- Tilting the head forward helps prevent saliva from going down the throat while the tablet is dissolving
- While the film or tablet is dissolving, have patients occupy themselves with an activity that doesn't require talking, like reading or watching television.
- Suggest rinsing their mouths or eating a mint prior to taking Buprenorphine to help with the taste.
- Patients with higher Buprenorphine doses might find it more comfortable to take their pills sequentially rather than all at once.
- For instance, a film can be placed on the left and right base of tongue; but if a third film is needed, it should be taken after the first two films have dissolved.
- Your patients should not try to take more than two tablets at one time.
On the first day of induction, patients can expect to feel some relief from their withdrawal symptoms within about 30 minutes of their first 4 mg dose. Most people feel markedly better after another dose or two. The persistence or return of withdrawal symptoms suggests that a higher dose is needed.
During maintenance, patients should ideally take their dose once a day around the same time each day. However, patients who need to split their dose (i.e. to get relief from symptoms) can do so if needed.
*We are using brand names since there is a difference in the product that is not reflected in the generic name. We are not advocating one brand or the other.