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2. Buprenorphine Formulations
Joji Suzuki, MD
Director, Division of Addiction Psychiatry
Department of Psychiatry,
Brigham and Women’s Hospital
Assistant Professor of Psychiatry,
Harvard Medical School

3. Sublingual (addiction treatment only)
Sublingual tablets (Zubsolv, generic): buprenorphine + naloxone
Sublingual tablets (Subutex): buprenorphine
Sublingual film (Suboxone): buprenorphine + naloxone
Buccal film
Bunavail: Buprenorphine+naloxone
Subdermal implant
Transdermal (pain only)
Injectable formulation
Buprenorphine Product Formulations Comparison -

4. Sublingual (addiction treatment only)
Sublingual tablets (Zubsolv, generic): buprenorphine + naloxone
Sublingual tablets (Subutex): buprenorphine
Sublingual film (Suboxone): buprenorphine + naloxone
Buccal film
Bunavail: Buprenorphine+naloxone
Subdermal implant
Transdermal (pain only)
Injectable formulation
Buprenorphine Product Formulations Comparison -

5. Sublingual (addiction treatment only)
Sublingual tablets (Zubsolv, generic): buprenorphine + naloxone
Sublingual tablets (Subutex): buprenorphine
Sublingual film (Suboxone): buprenorphine + naloxone
Buccal film
Bunavail: Buprenorphine+naloxone
Subdermal implant
Transdermal (pain only)
Injectable formulation
DEA waiver needed
Naloxone discourages injection misuse
Buprenorphine Product Formulations Comparison -

6. Sublingual tablet
Buprenorphine
50% bioavailable
Naloxone
Not well absorbed

7. Sublingual tablet Buprenorphine 50% bioavailable Naloxone
Not well absorbed
If tablet is crushed and injected:
Buprenorphine
Active
Naloxone: active
Displaces buprenorphine: withdrawal reaction
Patients do not favor injecting the combination Tablet

8. Sublingual tablet Buprenorphine 50% bioavailable Naloxone
Not well absorbed
If tablet is crushed and injected:
Buprenorphine
Active
Naloxone: active
Displaces buprenorphine: withdrawal reaction
Patients do not favor injecting the combination Tablet

9. Buprenorphine monotherapy
Allergy to naloxone
Pregnancy
Minimize exposure to naloxone
Avoid infant withdrawal

10. Buprenorphine/naloxone tablets
8mg/2mg
2mg/0.5mg
Buprenorphine Product Formulations Comparison -

11. Sublingual films: Suboxone
Buprenorphine Product Formulations Comparison -

12. Sublingual combination tablet: Zubsolv
Buprenorphine Product Formulations Comparison -

13. Buccal film formulation: Bunavail
Buprenorphine Product Formulations Comparison -

14. Key points Buprenorphine Partial agonist
High afinity at the mu receptor
Precipitated withdrawal
Combination tablet
Default choice for majority of patients

15. Key points Buprenorphine Partial agonist
High afinity at the mu receptor
Precipitated withdrawal
Combination tablet
Default choice for majority of patients
Avoid at all cost
Mild withdrawal

16. Key points Buprenorphine Partial agonist
High afinity at the mu receptor
Precipitated withdrawal
Combination tablet
Default choice for majority of patients
Avoid at all cost
Mild withdrawal

17. Key points Buprenorphine Partial agonist
High afinity at the mu receptor
Precipitated withdrawal
Combination tablet
Default choice for most patients
Avoid at all cost
Mild withdrawal

18. Next: Using Buprenorphine in Non-Specialty Settings