10 Buprenorphine Side Effects to Know About

Buprenorphine is a medication that treatsopioid use disorder (OUD). Some formulations also treatchronic pain. Certain formulations are approved for OUD only. This includes sublingual tablets (formerly Subutex) and extended-release injections (Sublocade,Brixadi). Buprenorphine and naloxone combination medications like the sublingual filmSuboxone also treat OUD. Other formulations such as a buccal film (Belbuca) and transdermal (skin) patch (Butrans) are only approved for chronic pain..

The side effects discussed here can happen with any oral medication containing buprenorphine. But we'll focus on buprenorphine sublingual tablets used to treat OUD in this article. Buprenorphine is afirst-choice treatment option for OUD. It can be extremely beneficial and even lifesaving for some people. But, like all medications, it has risks. Here, we'll discuss both common and rare buprenorphine side effects, and how to prevent or manage them.

Buprenorphine side effects at a glance

If you read the product information for buprenorphine, it may seem like it has a lot of side effects. But these side effects are usually mild. And more often than not, the benefits of treating OUD with buprenorphine outweigh the risks.

Mild buprenorphine side effects include:

• Headache

• Increased risk of infection

• Nausea and vomiting

• Constipation

• Mouth irritation

• Trouble sleeping

• Lack of energy

• Body aches and pains

• Mood changes

• Increased sweating

• Sexual side effects, such as erectile dysfunction

Serious buprenorphine side effects include:

• Mental changes that impair your ability to drive or do other activities

• Dental problems

• Low blood pressure

• Heart rhythm problems

• Liver problems

• Misuse

• Overdose

• Opioid withdrawal symptoms

• Withdrawal in newborns exposed to buprenorphine during pregnancy

1. Headache

Headache is the most common buprenorphine side effect. Body aches and pains can also occur. But before reaching for pain medication, there are a few things to consider.

Avoid usingopioids to treat your headache. Instead, consider at-homeheadache remedies like hydration, exercise, and meditation. Certaindietary changes may also help. Getting enough sleep is beneficial as well. You can also talk to your pharmacist about over-the-counter (OTC) pain medications. Examples includeacetaminophen (Tylenol) andibuprofen (Advil).

2. Nausea and vomiting

Nausea, vomiting, and upset stomach are possible buprenorphine side effects. But taking buprenorphine tablets correctly can often prevent these effects. Buprenorphine tablets aresublingual. This means they should be placed under the tongue until fully dissolved. Swallowing buprenorphine tablets can increase your risk of nausea. It can also make the medication less effective.

Staying hydrated and eating smaller (but more frequent) meals are two ways to settle your stomach if you're feeling nauseated. You can also talk to your pharmacist or prescriber about whether to try anOTC nausea medication. Some nausea medications may interact negatively with buprenorphine.

3. Constipation

Constipation is acommon opioid side effect. Buprenorphine is a partial opioid agonist. This means it binds to the samereceptors in your brain as opioid medications. So it can cause constipation like opioids do. However, it's not as likely as it is with typical opioids, which are "full" opioid agonists, such as hydrocodone.

It's best to prevent constipation before it happens. Stay hydrated, eatfiber-rich foods, andexercise regularly. If you're still struggling with constipation, ask your pharmacist about which OTC laxatives to use. Not all OTC laxatives work to treat opioid-induced constipation (OIC). Some options, such as a combination ofdocusate (Colace) andsenna (Senokot, Ex-Lax), may be more effective than others.

4. Mouth-related side effects

Since buprenorphine tablets are dissolved under the tongue, mouth irritation is possible. This may include gum redness, a burning sensation, or mouth numbness.

The FDA has also issued a warning about dental problems with oral buprenorphine. These problems include cavities, mouth infections, and even tooth loss. So it's important to keep going to regular dental appointments. And ask your dentist if they want to see you more often while you're taking buprenorphine.

You can take some steps to reduce your risk of mouth-related side effects. When you take your dose, make sure the tablet has completely dissolved in your mouth (this may take up to 10 minutes). Then take a large sip of water and swish it gently around your mouth and swallow. This will ensure none of the medication remains in your mouth.

Wait at least 1 hour before brushing your teeth after taking buprenorphine. This helps prevent damage to your teeth.

5. Mental impairment

Buprenorphine can cause drowsiness, dizziness, and "brain fog." That's why you'll see a warning about the potential for an "impaired ability to drive" on the package insert.

When you first start taking buprenorphine, avoid doing activities that require alertness. This includes driving. You should also avoid these activities if your dose increases. Wait until you know how buprenorphine affects you before resuming these activities.

Buprenorphine more often causes insomnia (trouble sleeping) than drowsiness. But if you're not sleeping well at night, daytime drowsiness can occur. If you're having sleeping problems, talk to your prescriber. And make sure you're practicing goodsleep hygiene habits.

6. Dizziness and low blood pressure

Buprenorphine can cause a condition called orthostatic hypotension. This is when your blood pressure drops when changing positions. For example, you may feel dizzy or light-headed when you go from sitting to standing. This puts you at risk for falls and injuries. This can be especially dangerous for older adults. This is because they are more prone to injury and hospitalization from falls.

Move carefully when changing positions. Be especially mindful of this when you first start taking buprenorphine or if your dose increases. You may need to sit or lie back down if you're feeling dizzy.

If your dizziness feels severe, it's time to be evaluated by a healthcare professional. Dizziness can be a sign of certain rare side effects caused by buprenorphine. For example, buprenorphine can raise your risk for a type of arrhythmia (abnormal heartbeat) called QT prolongation. It can also cause adrenal insufficiency. Dizziness is a common symptom of both of these conditions.

7. Liver problems

There have been reports of liver problems in people taking buprenorphine. These side effects are rare and can be minor, like a mild increase in liver enzyme levels. However, serious conditions like hepatitis and liver failure are also possible.

Although people taking buprenorphine have experienced liver damage, it's unclear if the medication is the true cause. Other factors like undiagnosed liver damage or viral hepatitis may be to blame. Your prescriber will check your liver enzyme levels before starting buprenorphine. This will help them screen for any existing liver problems.

8. Opioid withdrawal

Opioid withdrawal symptoms occur when your body becomes reliant on opioids. If opioid levels drop too quickly, it can cause uncomfortable withdrawal symptoms.

Buprenorphine actually decreases your risk of opioid withdrawal in most cases. But still, withdrawal can sometimes happen. Usually, it's due to taking buprenorphine too soon after your last opioid dose.

This is because buprenorphine binds more tightly to opioid receptors than full opioids. So taking buprenorphine too soon after taking typical opioids can trigger withdrawal symptoms. This happens because buprenorphine knocks the opioid off the opioid receptor. That's why you usually need to wait to start buprenorphine after taking an opioid. Usually, you should wait 12 hours after your last dose of a short-acting opioid, and at least 24 hours for a long-acting opioid.

Withdrawal can also happen if you stop taking buprenorphine abruptly or reduce your dose too quickly. So work closely with your prescriber if you want to stop taking buprenorphine. They'll likely reduce your dose very slowly if you've been on buprenorphine for a long time. And keep in mind that some people do best by taking buprenorphine indefinitely.

9. Misuse

Buprenorphine is acontrolled substance. This means it carries a risk of dependence and misuse. But this risk is much lower compared to full opioid medications.

Controlled substances are divided into categories depending on their potential for misuse. These are called schedules. Buprenorphine is a Schedule 3 medication. It's considered to have a low to moderate risk fordependence. In comparison, full opioid medications are Schedule 2. They have a high risk of dependence and misuse.

Be sure to follow your prescriber's instructions forhow to take buprenorphine. Don't take more than what's recommended, as this increases your risk of misuse and overdose. But don't take less either, as this increases your risk of returning to opioid use. Talk to your prescriber if your dose isn't effectively controlling opioid cravings or withdrawal symptoms.

10. Overdose

Buprenorphine overdose can happen if you take too much buprenorphine. It can also happen if you combine it with certain other substances. Avoid combining buprenorphine with other substances that can cause slowed breathing and overdose. These include:

• Benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan)

• Opioids, such as oxycodone (Oxycontin, Roxicodone) and tramadol (ConZip, Qdolo)

• Barbiturates, such as phenobarbital

• Alcohol

An overdose is a medical emergency. Symptoms of an overdose involving opioids like buprenorphine include:

• Pale face

• Pinpoint pupils

• Being unable to speak

• Falling unconscious

• Slow or irregular breathing

• Bluish skin

• Vomiting

• Slow or irregular heart rate

If you think you see someone having an overdose, call 911 immediately. Naloxone (Narcan, Zimhi) and nalmefene (Opvee, Zurnai) are medications that can quickly reverse the effects of an opioid overdose. Naloxone is available over the counter. For more information, check out another GoodRx Health article on how to give naloxone.

Even if you've administered Narcan, the person overdosing still needs emergency care. So call 911 immediately after giving Narcan. Narcan effects are temporary and don't replace care at the hospital.

Be aware that taking buprenorphine will lower your tolerance for opioids. If you resume taking opioids, an overdose could be caused by lower doses than what you're used to.

Good to know: Keep your buprenorphine stored in a safe location away from other people. Even a single tablet can cause an overdose for people who aren't used to taking opioids, especially children.