Can Suboxone Make Me Sick?

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When taken as prescribed, Suboxone should not make you sick.

Suboxone is a prescription medication designed to help treat opioid use disorder (OUD).

While Suboxone can cause side effects some people find unpleasant, it shouldn't make you ill when taken properly.

However, if you take the medication too soon after using opioids, you can experience what is called “precipitated withdrawal” which can make you feel acutely sick. 

What is Precipitated Withdrawal?

If you “feel sick” after taking buprenorphine/naloxone (Suboxone), most commonly, it's due to taking the medicine too soon after taking full opioids. Taking Suboxone too soon after taking an opioid can cause “precipitated withdrawal.” You may mistake your symptoms for drug side effects.

During precipitated withdrawal, any active opioid within your body is removed from receptors and replaced by suboxone. In essence, your body is deprived of the drugs it thinks it needs to feel normal and calm, and this sends you into a syndrome of withdrawal.

Issues like this are most common in people who use long-acting opioids (like methadone).[1] But it can happen to anyone who uses Suboxone too soon after using an opioid, including people who misuse fentanyl.[2]

Precipitated withdrawal symptoms include the following:

  • Aching muscles and bones
  • Nausea and vomiting
  • Diarrhea and abdominal cramping
  • Dilated pupils
  • Runny nose 
  • Yawning

Symptoms tend to begin within an hour or two of your first Suboxone dose and last for about 24 hours.[1]

To avoid any precipitated withdrawal when first starting Suboxone, wait about 12-24 hours after your last opioid, or when you feel the natural symptoms of withdrawal [3] You should talk about timing with your doctor before starting Suboxone to ensure you get the timing right.

Can Suboxone Make Me Sick When Taken Properly?

Like any medication, buprenorphine/naloxone (Suboxone) has side effects. Most are relatively mild and can be managed under close medical supervision, sometimes with relief from other over-the-counter medications.

Suboxone’s most common side effects include the following:

  • Constipation
  • Dizziness
  • Dry mouth
  • Excessive sweating
  • Fatigue
  • Headache
  • Insomnia
  • Nausea
  • Stomach cramps

You may not experience any side effects at all. But if you do, they're most common in the first few days of treatment. They may subside as your body adapts to the new medication. 

What to Do if You Feel Sick on Suboxone 

Before you take your first Suboxone dose, talk to your doctor. Ask about the side effects you should expect, and learn what to do if you feel ill while using your medication. Your doctor may offer some good advice you can use to feel better.

If your symptoms are severe or don't get better with time, tell your doctor, who will hopefully work close with you over the first few days and weeks of your therapy to ensure you are tolerating the medication well and adjusting your dose properly.

Sources

  1. Managing Opioid Withdrawal Precipitated by Buprenorphine with Buprenorphine. Drug and Alcohol Review. https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13228. January 2021. Accessed June 2022.
  2. Buprenorphine-Precipitated Opioid Withdrawal in the ED. Emergency Medicine News. https://journals.lww.com/em-news/Fulltext/2022/03000/Clinical_Pearl__Buprenorphine_Precipitated_Opioid.6.aspx. March 2022. Accessed June 2022. 
  3. Evidence of Buprenorphine-Precipitated Withdrawal in Persons who Use Fentanyl. Journal of Addiction Medicine. https://journals.lww.com/journaladdictionmedicine/abstract/9000/evidence_of_buprenorphine_precipitated_withdrawal.98967.aspx. November 2021. Accessed June 2022.

Medically Reviewed By 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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