Suboxone

buprenorphine / naloxone

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This is a summary of the European public assessment report (EPAR) for Suboxone. It explains how the Committee for Medicinal Products for Human Use (CHMP) assessed the medicine to reach its opinion in favour of granting a marketing authorisation and its recommendations on the conditions of use for Suboxone.

What is Suboxone?

Suboxone is a medicine that contains two active substances, buprenorphine and naloxone. It is available as sublingual tablets containing either 2 mg buprenorphine and 0.5 mg naloxone, or 8 mg buprenorphine and 2 mg naloxone. ‘Sublingual’ means that the tablet is placed under the tongue where it dissolves.

What is Suboxone used for?

Suboxone is used to treat dependence on opioid (narcotic) drugs such as heroin or morphine in drug addicts who have agreed to be treated for their addiction. Suboxone is used in adults and children over 15 years of age, who are also receiving medical, social and psychological support.

The medicine can only be obtained by ‘special’ prescription. This means that because the medicine can be misused or cause addiction, it is used under stricter conditions than normal.

How is Suboxone used?

Suboxone must be used under the supervision of a doctor who has experience in the management of opioid addiction. It is recommended that the patient’s liver be checked before starting treatment with Suboxone and should also be monitored regularly during treatment. The way Suboxone is used depends on the patient’s status: type of addiction, state of withdrawal, and whether the patient is already using another substitution treatment such as methadone before starting Suboxone.

The tablets must never be swallowed but should be placed under the tongue and allowed to dissolve, which usually takes five to 10 minutes. The recommended starting dose is one or two tablets of Suboxone 2 mg/0.5 mg. The doctor may increase the dose depending on the patient’s response but the daily dose should not be higher than 24 mg buprenorphine. Once the patient has been stabilised, the maintenance dose may be reduced gradually and eventually treatment may be stopped.

The effectiveness of Suboxone treatment depends on the patient also receiving other medical, social and psychological support. For full details, see the summary of product characteristics (also part of the EPAR).

How does Suboxone work?

Suboxone contains two active substances: buprenorphine, a partial opioid agonist (it acts like an opioid drug), and naloxone, an opioid antagonists (it counteracts the effects of opioid drugs).

Sublingual tablets containing buprenorphine alone have been available in the EU since the mid-1990s for the treatment of opioid addiction. However, buprenorphine tablets have been misused by drug addicts who dissolve the tablets and inject themselves with the resulting solution. The addition of naloxone helps prevent the misuse of the medicine. This is because, when injected, naloxone counteracts the effects of opioids, causing the patient to experience acute withdrawal symptoms.

How has Suboxone been studied?

One main study compared Suboxone with buprenorphine on its own or with placebo (a dummy treatment) in 326 heroin-dependent patients for four weeks, and measured the percentage of patients who had no trace of opioids in their urine at the end of the study. Patients also used a specially designed questionnaire to record their cravings, and the change in the questionnaire score before and at the end of the study was measured.

What benefit has Suboxone shown during the studies?

Suboxone was as effective as buprenorphine on its own and more effective than placebo: 17.8% of the patients who received Suboxone had a urine sample that tested negative at the end of the study, compared with 5.8% of the patients receiving placebo. The craving score, which was between 62.4 and 65.6 before treatment, decreased at the end of the study to 29.8 with Suboxone, compared with 55.1 with placebo.

What is the risk associated with Suboxone?

The most common side effects with Suboxone (seen in more than 1 patient in 10) are insomnia (difficulty sleeping), constipation, nausea (feeling sick), sweating, headache and withdrawal syndrome.

For the full list of all side effects reported with Suboxone, see the package leaflet.

Suboxone should not be used in people who may be hypersensitive (allergic) to buprenorphine or naloxone, or to any of the other ingredients. It must not be used in patients with severe respiratory insufficiency (difficulty breathing) or severe liver problems. It must also not be used in patients with acute alcohol intoxication (excessive alcohol consumption) or delirium tremens (a condition caused by alcohol withdrawal).

Why has Suboxone been approved?

The CHMP noted that the combination of an opioid analogue with an opioid antagonist is an established strategy for reducing the potential misuse of the medicine. The Committee decided that Suboxone’s benefits are greater than its risks and recommended that it be given marketing authorisation.

What measures are being taken to ensure the safe use of Suboxone?

The company that makes Suboxone will provide doctors and pharmacists with educational materials informing them of the risk of misuse, and reminding them to report specific side effects such as liver problems and effects on newborns.

Other information about Suboxone:

The European Commission granted a marketing authorisation valid throughout the European Union for Suboxone on 26 September 2006.

For more information about treatment with Suboxone, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Name Language First published Last updated
Suboxone : EPAR - Summary for the public BG = bălgarski 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public ES = español 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public CS = čeština 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public DA = dansk 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public DE = Deutsch 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public ET = eesti keel 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public EL = elliniká 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public EN = English 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public FR = français 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public IT = italiano 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public LV = latviešu valoda 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public LT = lietuvių kalba 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public HU = magyar 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public MT = Malti 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public NL = Nederlands 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public PL = polski 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public PT = português 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public RO = română 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public SK = slovenčina 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public SL = slovenščina 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public FI = suomi 19/10/2006 01/12/2011
Suboxone : EPAR - Summary for the public SV = svenska 19/10/2006 01/12/2011

This EPAR was last updated on 05/08/2014 .

Authorisation details

Product details

Product details for Suboxone
NameSuboxone
Agency product numberEMEA/H/C/000697
Active substance

buprenorphine / naloxone

International non-proprietary name (INN) or common name

buprenorphine / naloxone

Therapeutic area Opioid-Related Disorders
Anatomical therapeutic chemical (ATC) code N07BC51

Publication details

Publication details for Suboxone
Marketing-authorisation holder

RB Pharmaceuticals Ltd.

Revision10
Date of issue of marketing authorisation valid throughout the European Union26/09/2006

Contact address:

RB Pharmaceuticals Ltd.
103-105 Bath Road
Slough
Berkshire
SL1 3UH
United Kingdom

Product information

Product information

03/09/2013  Suboxone -EMEA/H/C/000697 -IA/0017

Name Language First published Last updated
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013
Suboxone : EPAR - Product Information SV = svenska 25/06/2009 10/09/2013

Contents

  • Annex I - Summary of product characteristics
  • Annex IIA - Manufacturing-authorisation holder responsible for batch release
  • Annex IIB - Conditions of the marketing authorisation
  • Annex IIIA - Labelling
  • Annex IIIB - Package leaflet

Please note that the size of the above document can exceed 50 pages.

You are therefore advised to be selective about which sections or pages you wish to print.


Name Language First published Last updated
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013
Suboxone : EPAR - All Authorised presentations SV = svenska 19/10/2006 10/09/2013

Pharmacotherapeutic group

Other nervous-system drugs

Therapeutic indication

Substitution treatment for opioid-drug dependence, within a framework of medical, social and psychological treatment. The intention of the naloxone component is to deter intravenous misuse. Treatment is intended for use in adults and adolescents over 15 years of age who have agreed to be treated for addiction.

Assessment History

Changes since initial authorisation of medicine

Name Language First published Last updated
Suboxone : EPAR - Procedural steps taken and scientific information after authorisation SV = svenska 25/06/2009 05/08/2014

Initial marketing-authorisation documents

Name Language First published Last updated
Suboxone : EPAR - Procedural steps taken before authorisation SV = svenska 19/10/2006  
Suboxone : EPAR - Scientific Discussion SV = svenska 19/10/2006  

Authorised

This medicine is approved for use in the European Union