Dosing the medication Suboxone correctly is important. Too much Suboxone could potentially lead to overdose, while too little can lead to relapse.
Initial Suboxone Dose
The first dose of Suboxone should be administered at least six hours after the last opioid use and when the patient is experiencing obvious symptoms of withdrawal.
Unlike methadone dosing, the Suboxone dose should be adjusted as quickly as possible to discourage drop-out. (See also: Suboxone vs. Methadone)
Patients are usually given 2 to 4 mg doses and monitored for 2 to 4 hours. If withdrawal symptoms are relieved, patients are released to return the next day. If continuing to experience withdrawal symptoms, an additional 2 to 4 mg can be given. The process is then repeated one more time up to 8 mg total.ⓘ
| Timeframe | Suboxone Film Dose |
| Initial Dose | Start with a single 2mg or 4 mg dose |
| Day 1 | Add an additional 2mg or 4mg dose every 2 hours up to a maximum daily dose of 8 mg |
| Day 2 | Take the previous day’s dose — if still feeling withdrawal symptoms add a 2 to 8mg dose up to a maximum daily dose of 16mg |
| Day 3+ | Continue daily dosing —the recommended maintenance dose is 16 mg but can be adjusted up or down in increments of 2 or 4 mg as needed |
Symptoms are assessed using the Clinical Opioid Withdrawal Scale (COWS).
Clinical Opioid Withdrawal Scale Workseet
Starting With Buprenorphine Only
Doctors used to start patients on buprenorphine-only medication (sometimes called Subutex). Then, transition patients to Suboxone on day 2 or 3. However, studies show precipitated withdrawals are caused by timing and not related to the naloxone ingredient.
Buprenorphine-only medication may be appropriate for patients switching from long-acting opioids like methadone, patients with a naloxone allergy or patients that are pregnant, but starting with buprenorphine-only medication is no longer standard practice.
How to Start Suboxone Today
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Suboxone Maintenance Dose
A typical dose of Suboxone for Opioid Use Disorder ranges from 4 mg to 24 mg.
Signs Your Suboxone Dose Is Too Low
Finding the right dose of Suboxone for each patient involves continued assessment and monitoring. The signs for increasing the Suboxone dose are:
- Moderate to Severe Withdrawal Symptoms (including anxiety, nausea or muscle aches)
- Drug Cravings Not Controlled
- Illicit Opioid Use
Suboxone Max Dose
Taking more than 24 mg of Suboxone a day has not been shown to provide any clinical advantage.
Suboxone has a ceiling effect, so taking excess of the medication does not provide greater effects. Since Suboxone is a partial opioid and does not give off a “high”, there is little incentive to increase the dose beyond what helps curb withdrawal symptoms.
Suboxone Overdose
Overdosing on Suboxone is very rare. It would be nearly impossible when following physician instructions for Suboxone drug interactions and dosage.
The exact Suboxone dose for an overdose depends on tolerance, metabolism and other substances involved. Alcohol and benzodiazepines (“benzos”) are usually involved.
- Buprenorphine has a “ceiling effect.” Taking more Suboxone doesn’t give more positive effects, so there is little reason to take a dangerously high dose.
- Suboxone specifically contains Naloxone, which reverses opioid overdose if Suboxone is injected. This makes Suboxone safer against overdose than buprenorphine-only medication (ie. Subutex).
- Slowed or difficulty breathing
- Extreme drowsiness
- Confusion
- Loss of consciousness
As with any suspected overdose, call 911. Narcan can help with Suboxone overdose.
Suboxone Pain Dose
The initial dose of Suboxone for chronic pain patients is typically lower compared to those using Suboxone for opioid addiction.
A maintenance dose of Suboxone for chronic pain may range from 4 to 16 mg.
One study shows 8 mg can be effective for the average chronic pain patient, while the recommended dose for opioid addiction patients is 16 mg.ⓘ
Suboxone Tapering Dose
It is recommended to gradually reduce the dosage of Suboxone over time instead of stopping cold-turkey. Tapering helps minimize withdrawal symptoms and allows the body to adjust to lower levels of the medication.
The specific tapering schedule and dosages vary, but the initial dose reduction may range from 25% to 50% of the current dose. After this initial reduction, subsequent decreases are usually smaller, such as 10% or less, to ensure a gradual and manageable transition.
Learn more about Dosing for Tapering Off Suboxone
How Long Should You Be On Suboxone?
There is no specific timeline for Suboxone treatment. Generally, patients should stay on long enough to stabilize life factors (like employment and housing), to set up support resources (like a 12-step sponsor or therapist) and to ensure underlying issues (like depression or anxiety) have been adequately addressed.
A Suboxone taper is usually required to stop the medication comfortably.
What Happens If You Miss A Dose of Suboxone?
Patients that miss a dose may start to feel withdrawal symptoms.
If patients remember within a few hours of the missed dose, take it as soon as possible. But, if it is close to the time for the next scheduled dose, skip the missed dose and continue with the regular dosing schedule.
Don’t double dose to make up for a missed dose. And, contact your medical provider for specific advice if unsure.
Suboxone Strengths
The brand name and generic versions of Suboxone are available in 2 mg, 4 mg, 8 mg and 12 mg films. Multiple films can be used to create any even number of doses.
| Buprenorphine Dose | Naloxone Dose | Brand Name |
| 0.7 mg | 0.18 mg | Zubsolv* Equal to 1 mg Suboxone which is not available |
| 2 mg | 0.5 mg | Suboxone, Generic Equal to 1.4 mg / 0.36 mg Zubsolv* |
| 2.1 mg | 0.3 mg | Buccal (Bunavail)** |
| 4 mg | 1 mg | Suboxone, Generic Equal to 2.9 mg / 0.71 mg Zubsolv* |
| 4.2 mg | 0.7 mg | Buccal (Bunavail)** |
| 6.3 mg | 1 mg | Buccal (Bunavail)** |
| 8 mg | 2 mg | Suboxone, Generic Equal to 5.7 mg / 1.4 mg Zubsolv* |
| 12 mg | 3 mg | Suboxone, Generic Equal to 8.6 mg / 2.1 mg Zubsolv* |
| 16 mg | 4 mg | Cassipa Equal to 11.4 mg / 2.9 mg Zubsolv* |
* The brand Zubzolv is better able to be absorbed by the body. The patient absorbs the same amount of medication with less medication.
** The brand Buccal (Bunavail) is only FDA-approved for pain, not for Opioid Use Disorder patients.
What is the Lowest Amount of Suboxone They Make?
The lowest dose of Suboxone is 2mg. The official recommendation from the manufacturers is to not cut the films. Though, it can be very difficult to taper from 2 mg to 0. Some patients take one 2mg dose every other day (instead of daily) to average out to 1 mg per day.
Zubsolv makes a strength equivalent to a 1 mg dose of Suboxone, but Zubsolv can be more expensive and harder to get.
Suboxone Absorption
Factors like saliva production, oral hygiene and individual differences in the mucous membranes influence how well and how long a specific dose of Suboxone works.
How Long Do You Feel the Effects of Suboxone?
The effects of Suboxone can typically last between 24 and 60 hours.
Suboxone has a longer half-life than opioids like morphine and heroin. Factors like dosage, metabolism and length of treatment impact how long the medication effects are felt.
How to Maximize Suboxone Absorption
1. Place the Medication Correctly
Suboxone is typically available as a sublingual film or tablet. To maximize absorption, place it under your tongue and allow it to dissolve completely.
2. Avoid Chewing, Swallowing and Talking
The medication is designed to be absorbed through the mucous membranes in your mouth. Try to minimize talking or swallowing to prevent movement or disruption.
3. Avoid eating or Drinking Beforehand
The general advice is not to eat or drink anything for at least 30 minutes before taking Suboxone. Food and beverages can interfere with the medication’s absorption by diluting it or affecting the pH levels in your mouth.
4. Don’t Take With Dry Mouth
Drinking a small amount of water beforehand or rinsing your mouth with water can help moisten the mucous membranes and facilitate absorption.
5. Follow Dosage Instructions
Taking more than the prescribed dose does not necessarily increase the effectiveness of the medication and may lead to adverse effects.
5. Consistent Medication Schedule
Taking Suboxone at the same time every day helps maintain steady blood levels of the medication, ensuring continuous relief from withdrawal symptoms.
14 Comments
Can u get high from suboxone 12mg sometimes I feel like I can take a 3rd 12mg
It is uncommon to experience a “high” or intense euphoria from Suboxone when taken appropriately. Usually the euphoria effect is mild and is more noticeable when first starting on the medication. If the euphoria is more pronounced or persists, then it is usually a sign that you are on too high of a dose of buprenorphine and it is recommended to decrease it.
What is considered a lethal does of Suboxone strips (causing death)how many mg
If you are not currently tolerant to opioids, any amount of buprenorphine could lead to lethal overdose, but is extremely rare to happen if done in a supervised medical setting. This is why it is very important to increase the buprenorphine gradually, usually maximum of 8mg in the first day, then 16mg the second day, in order to monitor the response to the medication. The vast majority of reported overdoses related to buprenorphine occur when the user injects the buprenorphine intravenously.
I was a daily heroin user for 25 years. In that time I was sometimes on high dose methadone as well. I’m clean now and on 18 mg of Suboxone a day. I take one and a half 12 mg strips. But I still have bad cravings. Could I go up in dose
Yes, you may benefit from increasing your dose to 24 mg of Suboxone daily. Due to the ceiling effect of Suboxone, there is very minimal benefit to going any higher than 24mg daily.
I am going through a kratom withdrawal and after 5 days of dosing I am at 2mg at 10am and 2 mg at 10pm. About 11am everyday I am lightheaded almost like an opioid high. Should I maybe stop my 10pm dose and see if that helps? I f I wake up at night I tend to be kind of drunk. My provider tells me this will pass, It has not changed yet
You should not be feeling “drunk” or “high” on the buprenorphine. If you are, that means you are at too high of a dose. If you are not feeling any other opioid withdrawal symptoms (i.e. chills/sweating, muscle aches, nausea, runny nose, watery eyes, restlessness), then I would recommend decreasing to 2mg once daily in the morning.
I am in Ohio my ins is not good. I am on 2mg suboxone twice a day for kratom withdrawal. Would it be possible to email me a chart to lower dose and get off? I have almost been on it 2 weeks
I would recommend decreasing your daily Suboxone dose by no more than 1mg per week. Since you have been taking 2mg twice daily, decrease to taking 2mg in AM and 1mg in afternoon for 1 week. Then decrease to 2mg daily for 1 week, then 1 mg, then discontinue. If you are feeling bothersome withdrawal symptoms, then adjust the tapering so it is more gradual.