Subutex

Opioids are painkillers such as codeine, morphine and diamorphine (heroin) that work by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors. However, opioids also act in the brain to cause feelings of euphoria and hallucinations. They can be addictive and people taking them long-term can become dependent on them.

Buprenorphine is an opioid that is used to wean people off their addiction to stronger opioids such as morphine, diamorphine (heroin) and methadone. It is prescribed as a substitute for such drugs. By acting on the same opioid receptors as other opioids, buprenorphine prevents the physical withdrawal symptoms that occur when these drugs are stopped. This prevents physical cravings. Over time, the dose of buprenorhpine is gradually reduced until it can be stopped completely.

Buprenorphine is only suitable as an opioid substitute in people who are moderately dependent on other opioids. This is because in addition to stimulating opioid receptors, buprenorphine also blocks them. In people who are dependent on high doses of opioids, this can cause withdrawal symptoms when the buprenorphine is started. For this reason, in people highly addicted to opioids, the daily opioid dose should be reduced gradually before therapy with buprenorphine is started.

For people taking methadone, the methadone dose should be reduced before this medicine is started. However, buprenorphine may still cause symptoms of withdrawal in people dependent upon methadone.

For drug addicts who have not undergone withdrawal, the first dose of this medicine should be taken at least 4 hours after the last use of the opioid, or when the first signs of craving appear. If it is taken earlier than this it can actually cause withdrawal symptoms.

Buprenorphine substitution therapy for opioid addiction must be used in combination with other medical, social and psychological treatment.

The Subutex sublingual tablets should be allowed to dissolve underneath the tongue. This allows the buprenorphine to be absorbed into the bloodstream through the rich supply of blood vessels found in this area. The tablets dissolve in about five to ten minutes. They should not be chewed or swallowed, as this would make them less effective.

What is it used for?

- Opioid (eg heroin) addiction

Warning!

- This medicine may cause drowsiness. If affected do not drive or operate machinery. Drowsiness will be made worse by alcohol, tranquilisers, sedatives and sleeping tablets such as benzodiazepines. Taking these in combination with buprenorphine can also cause potentially dangerous problems with breathing and so should be avoided while you are taking this medicine.
- Your liver function should be regularly monitored while you are receiving treatment with this medicine.

Use with caution in

- Decreased liver function
- Decreased kidney function
- People with breathing problems, eg asthma.

Not to be used in

- Children under 16 years of age
- Severely decreased liver function
- Severe breathing problems
- Alcohol intoxication (acute alcoholism)
- Serious medical condition caused by withdrawal from alcohol (delirium tremens)
- Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- The safety of this medicine during pregnancy has not been established. It is not recommended for use during pregnancy as it may be harmful to the developing baby, particularly in the third trimester, when it may cause breathing problems or a withdrawal syndrome in the baby after birth. Seek medical advice from your doctor.
- This medicine passes into breast milk. It may also inhibit the production of breast milk. Mothers who need to take this medicine should not breastfeed during treatment. Seek medical advice from your doctor.

Label warnings

- This medication is to be dissolved under the tongue.
- This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

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