If you are considering using Suboxone for opioid addiction or have already started treatment, you’re taking an important step toward recovery. Suboxone is a prescription medication that helps people overcome opioid dependence, and it’s natural to be concerned about its potential side effects. Understanding what to expect can help you feel more confident in your treatment journey and know when to seek medical attention.
The medication is a combination of buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). These two drugs help treat opioid use disorder by reducing withdrawal symptoms while blocking the euphoric effects of other opioids. Most side effects are manageable with proper medical care, and the benefits of recovery can far outweigh the risks for most people.
Understanding Suboxone and Why Side Effects Occur
Suboxone works by attaching to the same receptors in your brain targeted by other prescription pain medicines and illegal opioids. The buprenorphine component acts as a partial opioid agonist, which means it activates these receptors enough to prevent opioid withdrawal symptoms without producing the dangerous highs of the drug.
The naloxone component serves as an opioid antagonist, designed to deter misuse. When taken as prescribed sublingually (under the tongue), naloxone remains largely inactive. However, if someone tries to inject Suboxone, the naloxone may trigger severe withdrawal symptoms.
Side effects occur because your body is adjusting to the medication while healing from opioid dependence. Your nervous system, digestive tract and organs are all adapting to function without the presence of other opioids. This adjustment period is completely normal and typically becomes more manageable as treatment continues.
The good news is, serious unwanted effects are relatively rare when Suboxone is used under proper medical supervision as part of medication-assisted treatment.
Common Suboxone Side Effects You May Experience
Many people who start Suboxone experience some side effects during the first few weeks of treatment. Common side effects include:
- Headache. This is often the most noticeable early symptom, but it typically improves as your body adjusts to the medication.
- Digestive issues. These are very common and may occur because opioids, including the buprenorphine in Suboxone, slow down digestive system function, resulting in constipation. You may also experience nausea, especially during the first few days of treatment.
- Sleep disturbances and abnormal sleep patterns. You may also develop insomnia or excessive drowsiness during the day. Some people also experience unusual dreams or restlessness.
- Physical symptoms. These may include excessive sweating, dry mouth, muscle aches and fatigue. You may notice increased sweating even with minimal activity and persistent dry mouth that affects eating and speaking.
- Oral issues. When using the sublingual film or tablet, you may experience a sore mouth, a burning sensation, numbness or an unusual taste where the medication dissolves.
Most of these effects appear within the first few days of starting treatment and gradually improve over 2–4 weeks as your body adjusts to the prescribed dose.
Serious Side Effects That Require Immediate Attention
While most side effects are manageable, some serious side effects can occur that require immediate medical attention:
- Respiratory depression is the most dangerous potential side effect. Watch for slow, shallow breathing, pale skin or extreme drowsiness that’s difficult to wake from. This risk increases significantly if Suboxone is combined with alcohol, benzodiazepines or other central nervous system depressants.
- Serious allergic reactions can occur, although they’re rare. Signs of an allergic reaction include swelling of the face or throat, trouble breathing, severe skin rash or hives. These symptoms require immediate emergency care.
- Liver problems can develop, especially in individuals with existing liver conditions. Warning signs include yellowing of the skin or eyes, dark urine, severe abdominal pain or unusual fatigue. Blood tests are necessary to monitor liver function during treatment.
- Serotonin syndrome is a potentially life-threatening condition that can occur if Suboxone interacts with medications affecting serotonin levels. Symptoms include confusion, rapid heart rate, high fever, muscle stiffness and severe agitation.
- Adrenal insufficiency can develop with long-term use, causing persistent fatigue, muscle weakness, loss of appetite and low blood pressure when moving from a lying or sitting position.
If you experience any of these symptoms, seek immediate medical attention or call 911.
Dental Problems: A Critical Side Effect You Should Know About
In January 2022, the FDA issued a serious warning about tooth decay and dental problems associated with the buprenorphine component found in sublingual Suboxone. Over 300 cases of severe dental problems had been reported by the issuing date, including tooth loss even in people with no previous dental issues.
The sublingual film and tablet forms of Suboxone can cause dental problems through several mechanisms. The medication creates an acidic environment in your mouth, and many users experience dry mouth, which reduces protective saliva production. These conditions create the ideal conditions for rapid tooth decay.
Early warning signs include:
- Increased tooth sensitivity
- White spots on teeth
- Tooth pain or toothache
- Gum inflammation or bleeding
- Unusual taste in your mouth
Prevention is crucial, so after taking each Suboxone dose:
- Swish water around your mouth and spit it out.
- Wait at least 1 hour before brushing your teeth.
- Maintain excellent oral hygiene throughout the day.
- Schedule regular dental checkups every 3-6 months.
- Use fluoride toothpaste and consider a fluoride rinse.
Don’t ignore any early signs of serious dental problems. Regular dental care is essential for everyone taking sublingual Suboxone.
Long-Term Side Effects and What to Watch For
Extended use of Suboxone can lead to additional issues, including:
- Physical dependence that develops with regular use. This is different from addiction and an expected physiological response. Your body becomes accustomed to the medication, which is why stopping suddenly can cause severe withdrawal symptoms.
- Hormonal changes due to long-term opioid use, including Suboxone. Both men and women may see a decline in sexual desire. Men may experience decreased testosterone levels, while women may notice irregular menstrual cycles.
- Mental and emotional effects. These can include depression, mood changes or difficulty concentrating. Some people report feeling emotionally “flat” or less reactive to both positive and negative situations.
- Sleep-related breathing problems. These issues may worsen over time, especially in people with chronic obstructive pulmonary disease (COPD) or other respiratory conditions.
Regular monitoring through checkups and blood tests can help your medical doctor track potential long-term effects and adjust treatment as needed.
Managing Suboxone Side Effects Effectively
The “start low, go slow” approach can help minimize side effects. Your health care provider will typically begin with a lower dose and gradually increase it based on your response and needs.
- Proper hydration and nutrition are crucial. Drink plenty of water to combat dry mouth and help with constipation. Eat fiber-rich foods, and consider a stool softener if constipation becomes problematic.
- For oral health, follow the FDA recommendations consistently. Consider using sugar-free gum or lozenges to stimulate saliva production, but wait the appropriate length of time after each Suboxone dose.
- Monitor your symptoms and keep a journal of side effects. Be sure to include when they occur and their severity. This information can help your health care provider adjust your treatment plan.
- Never stop Suboxone suddenly without medical supervision. Even if side effects are bothersome, abrupt discontinuation can cause dangerous withdrawal symptoms. Work with your medical team to address concerns while maintaining your recovery progress.
Who Is at Higher Risk for Side Effects?
The likelihood of experiencing serious side effects increases with certain conditions and circumstances:
- Liver conditions, including hepatitis and cirrhosis, increase the risk of serious liver problems. Regular blood tests are essential for monitoring.
- Respiratory problems such as COPD, sleep apnea and other breathing disorders increase the risk of respiratory depression.
- Taking multiple medications — particularly benzodiazepines, MAO inhibitors and other prescription pain medicines — can create dangerous interactions.
- Advanced age, as older adults may be more sensitive to side effects, can increase the risk of drowsiness, confusion and falls.
Always inform your health care provider about all medications you’re taking, including herbal or vitamin supplements, and any preexisting medical conditions.
When to Seek Emergency Help
Call 911 immediately if you notice:
- Slow, shallow breathing or difficulty breathing
- Extreme drowsiness you can’t wake from
- Blue lips or fingernails
- Loss of consciousness
- Signs of serious allergic reaction (swelling, severe rash, trouble breathing)
For the following less urgent but concerning symptoms, contact your health care provider promptly:
- Persistent abdominal pain or vomiting
- Yellowing skin or dark urine
- Severe mood changes or thoughts of self-harm
- Signs of infection or unusual illness
Keep the Poison Control phone number (800-222-1222) readily available to get answers about potential overdose or medication interactions.
Supporting a Loved One Experiencing Suboxone Side Effects
If someone you care about is taking Suboxone, watch for concerning symptoms they may not recognize or report:
- Physical signs to monitor include unusual drowsiness, difficulty breathing, significant mood changes or complaints about persistent pain or discomfort.
- Encourage proper medical follow-up, and offer to accompany them to appointments.
- Support good oral hygiene by helping them remember to rinse after doses and keep up with dental appointments.
- Know when to intervene. If you notice signs of respiratory depression, loss of consciousness or a severe allergic reaction, don’t hesitate to call 911.
Remember, your loved one may feel ashamed or defensive about the side effects they’re experiencing. Approach conversations with compassion and focus on supporting their overall recovery journey.
Your Recovery Journey: Balancing Benefits and Side Effects
While side effects can be concerning, it’s important to know that medications such as Suboxone can reduce the risk of a fatal overdose by about 50% and help a person stay on track on their recovery journey from opioid addiction. Research has shown that medication-assisted treatment combined with behavioral therapy can provide better outcomes for individuals addressing opioid use disorder.
Most side effects are manageable with proper medical care and tend to improve as your body adjusts to treatment. Open communication with your health care providers is essential — they can adjust your Suboxone dosage, provide additional medications to manage side effects or explore alternative treatment options if needed.
Your recovery journey is unique, and finding the right balance of medications and support takes time. Experiencing side effects doesn’t mean you’re failing or treatment isn’t working. They’re often a temporary aspect of the healing process as your body and mind recover from opioid dependence.
Stay connected with your treatment team and follow their guidance about managing side effects. Remember — asking for help shows strength, not weakness. Recovery is possible, and you deserve support every step of the way.
Find Help or Answers to Recovery-Related Questions
Contact the National Rehab Hotline today for free, confidential guidance about addiction treatment and medication management concerns. We’re available 24-7 to connect you with local treatment options and answer your questions about the recovery journey.
