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What Is the Best Time of Day to Take Suboxone?

Suboxone can be taken any time of day as long as you stick to your schedule and take it at the same time each day as determined by your treatment provider.

The exact time may depend on how long it has been since you last took a full opioid agonist and where you are in treatment or recovery.

The First Dose of Suboxone

When deciding on the best time to take your first dose of Suboxone, you will need to look at when your last dose of a full opioid agonist was. Taking a full dose of Suboxone while a full opioid agonist is still active in your system can precipitate withdrawal symptoms and make you sicker.  Therefore, you ideally should be feeling some withdrawal symptoms before you take your first dose of Suboxone.

Generally, opioids stay in your body for varying amounts of time:

  • Short-acting opioid, such as heroin or Vicodin (hydrocodone): 6-12 hours
  • Intermediate-acting opioid, such as OxyContin (oxycodone) or morphine: 12-24 hours
  • Long-acting opioid, such as methadone: 36- 48 hours

It is important to already be feeling withdrawal symptoms when starting your first dose of Suboxone. This means that all other opioids are entirely out of the body and Suboxone will not therefore cause “precipitated withdrawal”.

The time of day you choose to take your first dose of Suboxone depends on how severely you are feeling withdrawal symptoms and when your last dose of a full agonist opioid was. If your last dose of heroin was at night, for example, you will likely want to start Suboxone the following morning about 12 hours after your last use of a full opioid agonist.

The First Few Days of Taking Suboxone

How much and when you take Suboxone after the initial dose will again depend on how you are feeling. Suboxone should make you feel better and minimize withdrawal symptoms.

It will take about 20 to 45 minutes for Suboxone to take effect. If Suboxone makes you feel worse, contact your provider right away as this could be precipitated withdrawal.

Typically, your first dose of Suboxone will be in the morning. Most providers recommend starting with a 2 mg dose the first time. If you are still feeling withdrawal symptoms one to three hours after your first dose, you can take a second 2 mg or even 4 mg dose in the afternoon.[2] You can repeat with a third or even fourth dose when needed, again with one to three hours in between doses and only if you are still feeling difficult withdrawal symptoms. Most providers would advise that you should not exceed 8 to 12 mg of Suboxone the first day. However each patient is very different which is why it is essential to be in close communication with your doctor for the first couple of days of starting Suboxone. Some providers even suggest that patients take their first few doses in the office (called “in office initiation”) so that their doctor can be close by to offer reassurance, provide suggestions and monitor symptoms.

Generally, you will only need one dose per day not to exceed 16 mg.[3] However every patient is different and dosing schedule is largely determined individually between each patient and provider. 

How Long to Continue Therapy

You can continue to take Suboxone as long as needed to keep drug cravings and withdrawal side effects from returning. Many people remain on Suboxone indefinitely.

SOURCES

  1. A Patient’s Guide to Starting Buprenorphine at Home. It Matters. https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed January 2022.
  2. Day One Starting Suboxone (Buprenorphine/Naloxone). British Columbia Ministry of Health. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/oud-induction-handout.pdf. Accessed January 2022.
  3. Suboxone Prescribing Information. U.S. Food and Drug Administration (FDA). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. Accessed January 2022.
  4. Clinical Opiate Withdrawal Scale (COWS). American Society of Addiction Medicine (ASAM). https://pubmed.ncbi.nlm.nih.gov/12924748/. Accessed January 2022.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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