Signs that Your Suboxone Dose May Need Adjusting

120,000 people lost their lives to opioid use last year — a 1040% increase compared to 2013. If current trends are any indication, these numbers will rise further.

Studies show that medication-assisted treatments — such as Suboxone — can lower the risk of opioid overdose by 50 percent. Thus, taking Suboxone (in its correct dose) is vital to combat opioid use disorder (OUD).

This article will help you recognize the signs of taking less than appropriate doses of Suboxone and allow you — and your prescribing physician — to adjust it for the best results.

What is Suboxone?

Suboxone is an oral medication FDA-approved for use in OUD. It contains two active ingredients — buprenorphine and naloxone.

Manufacturers prepare Suboxone tablets of varying strengths. For instance, a sublingual (under the tongue) Suboxone 2/0.5mg tablet contains 2 mg of buprenorphine and 0.5 mg of naloxone. Other formulations include:

• Buprenorphine 4 mg/naloxone 1 mg
• Buprenorphine 8 mg/naloxone 2 mg
• Buprenorphine 12 mg/naloxone 3 mg

What Happens After Taking Suboxone?

It takes buprenorphine 30 to 60 minutes — when taken sublingually — to become active within the body. Maximal effects can take up to 4 hours after ingestion.

How long Suboxone stays in the body varies and depends on your medical history, weight, and metabolism.

• Medical history: Certain conditions can affect how your body processes Suboxone. For example, suppose you have moderate or severe liver disease. In that case, Suboxone can stay in your system for much longer than a healthy individual.
• Weight: Generally, if you have a high body fat percentage, Suboxone will stay in your system longer.
• Metabolism: Enzymes such as CYP3A4 metabolize Suboxone. Your genes control the activation of these enzymes and thus how fast your body can break down Suboxone.

Why Getting the Right Suboxone Dosage is Important

Suboxone works to limit withdrawal symptoms and cravings. But, like any other medication, you must take an appropriate dose. Taking too much can be dangerous, while taking too little may be ineffective.

Studies show, in suitable doses, Suboxone can:

• Decrease opioid use
• Lower risk of opioid overdose
• Decrease risk of opioid-related side effects
• Improve the quality of life
• Decrease the incidence of hepatitis C and human immunodeficiency virus (HIV) among opioid users by deterring injectable use

Buprenorphine also lowers the risk of relapse by preventing withdrawal symptoms and cravings. This can be life-changing. For example, in a study following 110 patients taking buprenorphine, those who remained on the drug were likelier to have a job 18 months later. 

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Signs Your Suboxone Dosage May Be Too Low

How much Suboxone you need will depend on your reason for taking it and your response to treatment. For example, suppose you are taking Suboxone for pain and continue to experience pain and discomfort. In that case, this means your dose is too low. You will need to increase your dose under the care of a medical professional for adequate relief in such scenarios. This article will focus on the signs and symptoms of taking too little Suboxone for OUD.

Suboxone works by binding to the same opioid receptors as other opiates. In other words, when taken as a substitute for opioids, it reduces cravings and curbs withdrawal symptoms. In addition, since Suboxone only partially binds to opioid receptors, it is safer than other opioids. 

If your Suboxone dose is too low, you may experience withdrawal symptoms. Specifically, if your withdrawal symptoms are more than mild in intensity, or you need to self-medicate with opioids, alcohol, or benzodiazepines to manage your symptoms, you may be taking too little Suboxone.

How to Get the Correct Suboxone Dosage

Determining the proper Suboxone dosage is not an exact science. This is because the body's response to Suboxone and the required doses vary broadly amongst individuals. Thus, each user needs a personalized approach.

Your healthcare provider will generally adopt one of two approaches to optimize your Suboxone intake.

Approach 1:

This approach recommends beginning with a low dose of Suboxone. From there, based on your response — and the presence of withdrawal signs — the prescribing physician may increase the quantity to achieve an adequate response. 

Here's a simplified version of what this may look like:

• Day 1: The initial starting dose is buprenorphine 2 mg/naloxone 0.5 mg or buprenorphine 4 mg/naloxone 1 mg. Your doctor may increase this by buprenorphine 2 mg/naloxone 0.5 mg or buprenorphine 4 mg/naloxone 1 mg every two hours if you experience withdrawal symptoms. The total quantity of Suboxone you can take on day one is buprenorphine 8 mg/naloxone 2 mg.
• Day 2: Your prescribing physician may continue to increase your dose as needed. The total limit for day 2 is buprenorphine 16 mg/naloxone 4 mg.
• Maintenance therapy: Beginning day 3, your doctor will prescribe the lowest dose that achieves an adequate response for you. This may range between 4 to 24 mg of buprenorphine and 1 to 6 mg of naloxone daily. Studies show buprenorphine is unlikely to be effective at doses greater than 24 mg. Thus, amounts greater than 24 mg are rarely necessary. 

Approach 2:

An alternative approach is to start at a higher Suboxone dose and then reduce intake if needed. Studies show this approach can increase user compliance and lower the risk of opioid overdose. For example, a study found that patients starting on higher doses of Suboxone (e.g., 16mg or greater) were less likely to stop treatment during their first month of therapy.

Other dosing information

Based on your maintenance dose, your Suboxone intake is classified as:

• Low if you are taking less than 8 mg
• Medium if you are taking between 8 to 24 mg
• High if you are taking 24 mg or greater

It does not matter whether you take low-dose buprenorphine or high-dose buprenorphine as long as it works safely and effectively.

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Other Frequently Asked Questions (FAQs)

Can I Increase my Suboxone Dosage?

Always consult your healthcare provider if you feel like your current Suboxone dose is insufficient. Confidant makes this more accessible than ever with its virtual consultations.

How Much Suboxone is too Much?

Studies show doses greater than 24 mg/6 mg daily have no advantage over lower doses. Thus, doctors recommend not exceeding this dose. However, remember that this is a general guideline, and your specific situation may vary.

In addition, although Suboxone is safe, there is still a slight risk of overdose. Symptoms of Suboxone overdose include:

A Suboxone overdose can be fatal. If you experience signs of an overdose, immediately call 911 or visit your nearest emergency room.

Receive Professional Suboxone Advice with Confidant

Confidant is an all-encompassing virtual Suboxone clinic. Some of our hallmark treatments include online therapy, medication-assisted treatments (MAT), and recovery coaches.

In addition, our physicians can answer any questions you may have. If you’re unsure where to start please consult our ReVAMP program. Answer questions about how you’re feeling, your recent activities, and your goals and ReVAMP will create a personalized plan for you. It’s free and available in the app now.  Get in touch today!

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