Jane asked
I need to know the difference in suboxone and bunivail. Do doctors prefer one over the other!
Answer
Suboxone and Bunavail both contain the same active ingredients:
- Buprenorphine
- Naloxone
Suboxone films are intended for sublingual administration, but can also be dosed buccally (inside the cheek). Bunavail films are for buccal use only.
Differences Between Suboxone & Bunavail
Although Suboxone and Bunavail contain the same active ingredients, there are a number of differences between the two including:
- Suboxone films can be dosed sublingually or buccally
- Bunavail films can only be dosed buccally
- Bunavail has greater absorption and bioavailaiblty compared to Suboxone
- Less medication is "wasted" with Bunavail when compared to Suboxone
- Suboxone & Bunavail are available in different doses
Absorption & Bioavailability
Bunavail has greater absorption and is more bioavailable than Suboxone. Therefore, Bunavail is available in different dosages as less is needed when dosing comapred to Suboxone.
Suboxone is available in the following strengths:
- 2 mg/0.5 mg buprenorphine / naloxone
- 4 mg/1 mg buprenorphine / naloxone
- 8 mg/ 2 mg buprenorphine / naloxone
- 12 mg/4 mg buprenorphine / naloxone
Bunavail is available in the following strengths:
- 2.1 mg / 0.3 mg buprenorphine / naloxone
- 4.2 mg / 0.7 mg buprenorphine / naloxone
- 6.3 mg /1 mg buprenorphine / naloxone
Per the package insert insert for Bunavail, A Bunavail 4.2 mg/0.7 mg dose provides equivalent buprenorphine exposure to Suboxone 8/2 mg. Below is a conversion chart for the remaining strengths:
Suboxone Film To Bunavail Conversion Chart
| Suboxone Sublingual Tablet Dosage Strength | Equivalent BUNAVAIL Buccal Film Strength |
|---|---|
| 4/1 mg buprenorphine/naloxone | 2.1/0.3 mg buprenorphine/naloxone |
| 8/2 mg buprenorphine/naloxone | 4.2/0.7 mg buprenorphine/naloxone |
| 12/3 mg buprenorphine/naloxone | 6.3/1 mg buprenorphine/naloxone |
What the above chart illustrates is that it takes less bunavail to equal the same dose as Suboxone provides. Below, is an illustration from the Bunavail marketing website:
This greater absorption of Bunavail may lead to less GI problems like constipation.
How Buprenorphine/Naloxone Products Work
Buprenorphine
Buprenorphine is the medication in Suboxone and Bunavail that is responsible for the effects of the drug. Unlike commonly used opioids such as morphine, oxycodone and hydrocone, which are full opioid agonists, buprenorphine is a mixed agonist/antagonist. This means that it is an agonist (actually a partial agonist) at mu receptors and an antagonist at the kappa receptors.
The mu agonist effects translate to analgesia while the antagonistic effects at the kappa receptors produce less effects on respiratory depression, dysphoria and euphoria when compared to full opioid agonists like oxycodone. Buprenorphine helps with pain relief and doesn't have the propensity to cause breathing issues or the effects that traditional opioids do.
Naloxone
Naloxone is a full opioid antagonist at the mu receptor. In fact, it is used for opioid overdoses as it reverses effects of opioids acting on the mu receptor. When Suboxone and Bunavail are used as directed (sublingually or buccally), the effect of naloxone is minimal due to low bioavailability. It is added to Suboxone and Bunavail for the sole reason of deterring abuse.
If Suboxone and Bunavail are injected, not only will the effect of buprenorphine will be reduced, it may even precipitate withdrawal. It is important to note that naloxone in these formulations in NOT absorbed well and generally will NOT have any noticeable effect if taken as prescribed. Naloxone is simply added to Suboxone and Bunavail to prevent abuse of the drugs.
