I’ve received several complaints from patients and readers about one of the current buprenorphine formulations. The primary complaint is that the tablet is ‘not ‘working as well as the other formulations;’ that it seems to wear off earlier, or that people feel compelled to take more than what is prescribed.
Buprenorphine 8 mg tabs
My understanding, admittedly based only on what people have told me, is that there are three current formulations of buprenorphine. The brand form, Subutex, comes as a relatively-large, flat-oval tablet, white or off-white in color. The Roxanne version is a round white tablet, with a diameter of about 0.5 inch. The tablet people have complained about is from Teva, and is smaller; about the size of a tic-tac.
In general, I think that generics are as good as brand name medications. I have never come across a reliable instance, in my practice, of generics being less potent or less active. I recognize that particularly for psychiatric medications, the placebo effect accounts for significant portions of the actions of medications—so if a person BELIEVES that generic fluoxetine is less likely to work, it IS less likely to work. But take away the placebo issue, and a molecule of fluoxetine is a molecule of fluoxetine—regardless of where it comes from.
That said, I realize that the delivery of molecules can be affected by the design of capsules and tablets. I remember a study, years ago, that showed that many of the vitamins sold in the US passed through the intestinal system without even dissolving, let alone getting into the bloodstream. If the active substance is encased inside insoluble resin, there is little to be gained from taking it.
The delivery issue is less of a concern with a medication that is delivered through the oral mucosa, as with buprenorphine. There are several factors that affect absorption of buprenorphine; the concentration of buprenorphine in saliva, the amount of surface area that buprenorphine is allowed to pass through, and the time allowed for that passage to occur. If the smaller tablet dissolves more slowly, molecules of buprenorphine may have less actual contact-time with oral mucosa, thereby reducing absorption.
On the other hand, I am well aware of the psychological reward that people describe from taking buprenorphine or buprenorphine-naloxone, even in the absence of any subjective sensation. The fear of withdrawal is relieved by taking buprenorphine—making the dosing experience ‘rewarding.’ It may be that the smaller tablet provides less reward, as the small size engenders less confidence in those unfelt ‘effects.’
In any case, I invite readers to share their experiences, just in case those who have already written are truly onto something. Please leave comments below—and thanks for sharing!
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27 Comments
scruffy2 · February 17, 2012 at 3:52 pm
DRY MOUTH – MINIMAL TRANSFER IN MOUTH (UNDERMEDICATION RISK)
I am convinced that the variation in sizes of these sublingual tablets makes a great difference in how well these tablets are ingested into the mucous membranes. Especially important is saliva production – In cases of too little saliva the smaller pill may make no difference or even be helpful. But in cases of dry mouth
“cotton mouth” condition the smaller pill does not produce or stimulate saliva to near the degree that the three times larger pills did.
In a dry mouth, the tiny pill (8 mg Buprinorphine) might well dispense a tiny fraction of the medicine into the body. The instructions for full absorbtion of pills requires saliva to be held for a period of time, and I have heard from others that the small pill is a problem. They should not be the only thing available as a generic.
scruffy2 · February 17, 2012 at 4:59 pm
In the pictures above I do not see the small pill of concern- a Subutex generic (8mg) from Hi Tech – or arrow.
It is indeed the size of a tic-tac, hard to break, and dissipates in the mouth quickly. The one that was larger came from Teva and worked fine. Thus far the only small problem pills I have seen have been from Hi Tec, or Hi Tech corp. There is an arrow on the small pill and the number “8”.
Breaking can destroy the structure, but mainly it just does not feel like the medication gets through and works.
SuboxDoc · February 20, 2012 at 6:18 pm
Hmmm… I only could find these three forms. If you find a picture on the internet, send me the attachment– I’ll include it here.
Thanks for the information!
t-time · February 28, 2012 at 9:03 am
Actually, I live in France (US citizen, EU resident) and Arrow makes a generic here (as described above, a very small round white tab with “8” on it, actually, here they come in 0.4, 1, 2, 4, 6, or 8 mg size) and I fully agree they do not seem as effective as the brand name, Subutex. The other type, Suboxone, is not available here, only Subutex. They come in boxes of 7 (regardless of dose) – and the Dr. appointments are free – we only pay for the medicine. The only requirement is you must visit the Dr. every 4 weeks – but other than that the idea of long term maintenance is well accepted and if you are a FR citizen, even the cost of tabs are covered. Oh yeah, I forgot, Americans hate socialized medicine – so I won’t say anymore!!
SuboxDoc · March 1, 2012 at 4:51 pm
The thing that people in those countries forget, of course, is that nothing is ‘free.’ SOMEONE is paying for it. Your Greek friends to the South have learned exactly how getting things ‘free’ works…
I prefer a system where people ‘have skin in the game’– i.e. live within their means, and contribute something to their own sustenance. Each tab of Suboxone you enjoy– ‘for free’– is coming to you by skimming money from someone else’s paycheck– another person’s hard work. While the US flushes ever-closer to such a scenario, there are still US citizens who remember, with pride, the principles that make the US different; the sense that each of us should do our best to pay our own way through life.
Of course, I’m just a filthy capitalist!
RIP Andrew Breitbart
mermaid · March 12, 2012 at 5:05 am
Yet in Australia our suboxone is different shape yet again plus when we go to dose at the chemist it is crushed up by them and then put under our tongue. In Western Australia we are dosed daily but in other states it can be weekly or twice a week. As i have been on the program awhile and i never miss dosing i get 2 takeaways each week which i break up a bit and put under the tongue. I did see a doctor monthly but as i live in a small remote mining town alot of doctors etc come and go and at the moment we dont have a doctor but my scripts are faxed up here every month and soon we will have a doctor flown up here just to see us and write scripts every 3 months in which is taken care of under our hospital system. A doctor visit used to cost $72 but we get $35 back. Our daily dose costs $4 no matter how much you are on and last time i checked we were 1 of the very few countries that arent in a recession thanks to lots of mining here
serotonin · July 22, 2012 at 2:18 pm
There is a generic brand made by Hi-tech . The 8mg is the same size as the suboxone 2mg tablet.
I take the roxanne brand of subutex and sometimes they will give me the hi-tech at the pharmacy I go to. I always ask for the roxanne because I feel it is not effective at all, how can an 8mg be the same size as the non-generic 2mg sub? It is not as effective as I thought and do not want to take it again.
vez · September 26, 2012 at 9:24 am
Hello All i Have Had All The Generics Teva, hi-tech which is made by arrow and is marketed by hi-tech
in the usa but used to be marketed by midloathan products ,and of course (Roxane the worst) Hi-Tech works well but it seems sedating as teva feels like the original almost ,But not as it only gives you that get up and go feeling a little. Branded subutex was much better than all these generics i think rickitt benkeyser or how ever you spell it should be sued by making this drug and then pulling it off the market because there patient
was up they want you to take that film that nalaxone had my legs blowing up with fluid not to good on the liver and the headaches i think its better to stick to one generic as i had the high tech and some of the teva
and i found myself likeing both Generics Are not all created equal its unbelieveable i just wish i could get off this stuff its very hard. Only take it for a week at most 5 days would be better start at 2mg and wean down to .025 over the course of a week that is how it should have been marketed But MONEY IS MONEY
and that is all its about but i know teva is o.k. and hi-tech is ok too but all not the same as subutex GOOD LUCK ALL ONLY IF HERE IN U.S.A. THEY WOULD ALLOW IBOGANE TRAETMENT I HAVE HEARD IT WORKS WOUNDERS BEST REGARDS,VEZ
Lindsey F · March 12, 2017 at 9:12 am
I have been on Suboxone for a few years now because the one time I tried to come off I relapse and my life has never been better have a five-month-old beautiful little girl and feel like I owe it to buprenorphine which saved my life I am on the generic now. I love the rocks and tablets I think they work the best they are the bigger round white tablet with 54 411 on them the high-tech brand is the absolute worst in my opinion they are very small and not nearly as effective. right now my Pharmacy that I use is out of the rocks and brand and I am having no choice but to get the westward brand which I have never seen before if anyone has any idea if this is a small or bigger size pill I would appreciate it if you could let me know because when you like to break them in half like me it is very difficult with the smaller ones, not to mention I just feel that they do not work as well at all!
Jeffrey Junig MD PhD · March 12, 2017 at 8:42 pm
Yes– I think you mean Roxanne brand– that is what people usually prefer, and yes, hi-tech is not liked by any of my patients. The choice is by pharmacies, looking for the best deal– so you may want to call area pharmacists and see what they have.
Garry · April 19, 2017 at 8:10 pm
Hey Lindsey! I know it’s been a little over a month since your post, but I too am currently on the generic Subs. I just got my script 2 days ago and I ended up getting the west ward brand tablets as well. I have never seen them before and I searched through the forums and what not and I can’t find any info on them. I’m pretty sure they are fairly new. Now, I’m sure you have picked your script by now and I have seen/taken them, yeah? They are the bigger sized, round, peach tablets. I haven’t been able to find anyone else who has tried them. So I would love to hear your thoughts on them? What did you think of the quality/ strength of the west ward brand?
Thanks!
Jeffrey Junig MD PhD · April 20, 2017 at 5:44 am
Gary, maybe Lindsey will stop back– but check out the forum at http://www.suboxforum.com. We get about 6000 visitors every DAY– you’ll find people there who’ve tried it, I would think. There is no charge, and you can use a fake name to register if you want.
Ash · July 7, 2017 at 11:00 pm
So I’ve been taking suboxone 8 mg for years. Then I recently switched to Subutex for cost reasons. Everything seemed find then 3 weeks later out of the blue. Restless legs. My question do I need to up my dose ?
Jeffrey Junig MD PhD · July 9, 2017 at 7:23 pm
That’s unusual. As you know, the medications have an identical effect. I suspect the problem is coming from reduced absorption of buprenorphine, so that by the end of three weeks your blood levels have gradually gone down. On average, about 30% of a dose of Suboxone gets absorbed, and that percentage is reduced by dilution if you have a small pill and lots of saliva. Take a look at this post: http://suboxonetalkzone.com/optimizing-buprenorphine-absorption/
Jay Overstreet · April 18, 2017 at 10:24 am
I take buprenorphine (Subutex generic and not Suboxone). I am prescribed 2-8 mg tablets a day which I break in half. I basically take 4 mg every 4 hours. That seems to work best for me. The pill size is a very BIG deal for me. The very small pills (about the size of a dilaudid) are so small that they can become diluted in the presence of excess saliva. When you have excess saliva and this small pill (which I break in half) gets lost/diluted in your mouth, you end up swallowing too much of the medication. When the buprenorphine is swallowed, it is not absorbed well through the GI tract and the medication is wasted. Basically, the surface area of the small buprenorphine pill is too low for the sublingual delivery method. You need the brand name or the larger generic pill in order to get efficient delivery of the medication. I can speak on the strip or suboxone. My experience is limited to buprenophine only. On the larger pill, my 30 day rx will last 5 weeks. With the tiny pill, it only lasts about 3 weeks. Its $150 for each doctors visit so that matters. Its the surface area of the pill that matters.
Jeffrey Junig MD PhD · April 18, 2017 at 1:02 pm
Check out my post about ‘optimizing absorption’– that will help with the smaller pills!
ray · April 20, 2017 at 7:55 am
Hi,
In Canada and on .5mg of suboxone, the pharmacist must break a small 2mg tablet into 4 pieces. I’m constantly arguing with her about the count or size of the quarter i get. Some days its perfect and other days i get the crumbs, its no different than arguing with a street dealer, its almost fun to play the game with her. When i get a small piece it is mental torture for me, just waiting to get sick. When i get a good quarter, I’m grooving all day. I know its all in my head but that’s just the way it is and i’m sure i’m not alone.
My main concern and the Doctor can’t explain either is i feel fine on .5mg but when i take a half a pill or 1mg i get violently ill, sever headaches chest pains etc.ect.
Well i have to agree size does matter. Thanks, Ray
Jeffrey Junig MD PhD · April 20, 2017 at 5:35 pm
Naloxone is barely absorbed, and has a very short half-life– so all of the symptoms or effects are caused by buprenorphine. I don’t know where your tolerance was, but ot sounds like the buprenorphine was stronger than what you were used to, and caused sedation, nausea, and abdominal cramping– which are typical symptoms of opioid everydose.
You will probably tolerat it better now than a few days ago as your tolerance has increased.
Rememer too that buprenorphine absorption changes depending on the amount of saliva, how long it is in your mouth, ect– which probably relates to the size of the tablet.
Jeffrey Junig MD PhD · April 20, 2017 at 5:35 pm
Naloxone is barely absorbed, and has a very short half-life– so all of the symptoms or effects are caused by buprenorphine. I don’t know where your tolerance was, but ot sounds like the buprenorphine was stronger than what you were used to, and caused sedation, nausea, and abdominal cramping– which are typical symptoms of opioid everydose.
You will probably tolerate it better now than a few days ago as your tolerance has increased.
Rememer too that buprenorphine absorption changes depending on the amount of saliva, how long it is in your mouth, ect– which probably relates to the size of the tablet.
Fred Cakin · April 25, 2017 at 12:25 am
I’ve taken ALL of the types of brand/generic Subutex here in the USA. Suboxone made me projectile vomit due to highly adverse to Naloxone in it–no matter the amount. I MUCH prefer the smaller ones as they are not loaded with all that ‘filler’ and makes them seemingly quicker to work and quite potent! Can’t break them into 1/8’s only 1/4’s….but are very hard and work like a charm for me and have for a coupla years. Guess it’s to each, their own aye? Also, small ones are more expensive, why?, cause they’re harder to find here in the SE USA…..give them another shot if u r waivering as I have clients who 100% agree with me! We say taking that huge pill is like taking an Alka-Seltzer, ha!!!
Terry · May 31, 2018 at 10:14 am
This may sound ridiculous but i worry about suboxone salava that i get on my vapor device body from vaping the residue can get on objects and be dangerous to a child if they touch it and they eat something i am worried terrible about this
Jeffrey Junig MD PhD · May 31, 2018 at 7:43 pm
I’m not sure what you’re saying. You’re thinking that your saliva will get on a vapor device, and that will result in buprenorphine residue on objects in the room? I don’t see reason for concern… unless you’re drooling gallons and gallons of saliva, and your vapor device somehow has the power to put those gallons of saliva into the air of your living area.
Understand that the amount of buprenorphine in the saliva of a person taking the medication is very, very tiny. Your body has liters and liters of fluid that the buprenorphine distributes in, and most of the buprenorphine is bound to protein in your blood and lymph and not vaporized when that fluid evaporates. Some potent opioids are volatile, notably fentanyl. And in some surgeries patients are given HUGE doses of fentanyl – mainly the old-fashioned cardiac bypass surgeries. But buprenorphine is less volatile, and so it is not going to float around a room and the condense onto objects in the environment.
You may be aware of the article in Mens Health that described my personal addiction. The author noted that trace amounts of fentanyl have been detected in anesthesiologists, caused by fentanyl vaporizing out of patient wounds and into the air in the OR. But those were very tiny amounts, below what would have any effect on people.
Interesting idea… but I can’t imagine a way for buprenorphine to endanger someone in that way. The atoms in the ambient air would be tiny, tiny fractions of the amounts necessary to have a meaningful effect on another person- even a small child. Think of it this way — thousands, maybe millions of autos release carbon monoxide into the air of your town each day. But if your own car is turned off, you have no reason to fear the many molecules of carbon monoxide floating around you. They are orders of magnitude less than what is needed to affect you.
Terry · June 8, 2018 at 8:01 pm
What I actually meant is the salava actually left in the mouth after taken the strip the salava on the vapor device mouthpiece by using it then putiing the device in your pocket and then it possibly getting on the vapor device body then handling it after pulling it out of your pocket the bupe getting on other objects however miniscule it is and possibly doing this s several times over a period a time just worry bout the transfer of the bupe onto objects and eventually touch d by a child then they eat something may sound very weird but i worry
Terry · June 14, 2018 at 7:37 am
What I actually meant is the salava actually left in the mouth after taken the strip the salava on the vapor device mouthpiece by using it then putiing the device in your pocket and then it possibly getting on the vapor device body then handling it after pulling it out of your pocket the bupe getting on other objects however miniscule it is and possibly doing this s several times over a period a time just worry bout the transfer of the bupe onto objects and eventually touch d by a child then they eat something may sound very weird but i worry,this just troubles me Doc
Terry · June 11, 2018 at 1:44 pm
Please Doc leave me a reply
Jeffrey Junig MD PhD · June 26, 2018 at 2:02 pm
I’m sorry- I haven’t logged in for awhile! I understand your concern. Let’s think it through… so you have, say, 8 mg dissolved in saliva. I would guess that a person generates about 1 cc of saliva while holding the med in the mouth for 10 minutes… then let’s imagine that a tenth of that saliva is transferred by some object. Or maybe the person accidentally drools a couple drops… in that situation yes, I can imagine that spilled saliva containing a significant amount of buprenorphine. But then that saliva would need to get into the mouth of another person, and that is harder to picture. I suppose a child could take the part of clothing where the saliva had fallen and suck on the fabric…
I can see how a ‘freak accident’ could happen in that way, but many things would have to line up. When saliva gets on something and dries, it becomes a crust that will rub off as dust that is shuffled with all of the other little bits of dust in the environment, making it unlikely that a person could get exposed to a significant amount. But I do see your point. Buprenorphine is a potent and stable molecule. The situation is similar to the situation with testosterone creams, which can transfer to children and cause problems. I think it is good that you are aware of the dangers, but the chance of having a problem is very low.
Melissa · January 2, 2019 at 3:34 am
I feel like if i take a piece of a suboxone in the morning n a piece at night..it works better….if its small or smaller than usual then yes it does feel like it isn’t working or working that good or working for as long as they should…and i feel it all depends on your metabolism because some days i do need another little piece of one i don’t take a whole one all at once because i feel the same way when i take a piece of suboxone i still need a piece later on it doesn’t last longer because i took more at one time and that’s for sure….