Most people are accustomed to short courses of medication. We get an infection, and we take antibiotics, and then we move on. Suboxone is different.

Suboxone quells your opioid use disorder (OUD) symptoms, allowing you to live a life free from addiction. But for many people, quitting the medication means returning to opioid misuse. Staying on the medication is the best way for many people to retain their life in recovery over the long term.

Your doctor can help you determine how long you should take Suboxone. And if you’re considering quitting your medication because of side effects, your doctor can help with that too.

What Are the Long-Term Effects of Suboxone Use?

Suboxone contains buprenorphine and naloxone, and doctors manage your dose very carefully. If you remain on the drug for long periods, you could experience health issues. Your doctor can monitor you closely and help if they appear.

These are a few issues associated with long-term Suboxone:

Withdrawal Problems

The buprenorphine in Suboxone is a partial opioid agonist. All drugs in this class can cause physical dependence, meaning people can feel sick when they don’t take their medications.[1]

Withdrawal symptoms include the following:

• Headache
• Diarrhea
• Flu-like symptoms
• Watery eyes

Mixing Suboxone with alcohol or other depressants can make withdrawal symptoms worse, and it is also very dangerous.

Liver Issues

Each dose of Suboxone is processed by your liver. If you remain on the medication for a long time, you could do damage to this critical organ, though this happens rarely in people without pre-existing liver problems.[1] You could develop jaundice (where your skin turns yellow), or you could have no symptoms at all. Regular monitoring can help your doctor spot this problem.

Mental Health

Some people experience a so-called flattened aspect while taking Suboxone. The medication calms the brain, making people less likely to flare into anger or sweep into depression. This could be a benefit, but it could also make you feel unlike yourself.

Stigma

Many believe that people shouldn’t use medications like Suboxone for a long time. Some doctors even hold this opinion.[2] They are incorrect, but the longer you stay on the medication, the more unpleasant comments you might hear from people who don’t understand what you’re doing.

What Are the Benefits of Long-Term Suboxone Use?

Experts recommend long-term maintenance medication for OUD.[3] People who remain on Suboxone long-term are much more likely to experience sustained recovery from OUD, resulting in fewer instances of opioid misuse and fatal overdose due to such misuse.[4]

With OUD, the potential for relapse remains high in some individuals, even after months or years of abstinence from opioids.[5] As a result, continuing medications can be crucial during the first few years of recovery. Remaining on Suboxone greatly reduces the likelihood of relapse.

Long-term Suboxone use is not associated with any significant health effects.

If you have been taking Suboxone for a long time, you may experience withdrawal when you stop taking the medication. This can be managed with a tapered approach to stopping use.[6]

If you and your doctor decide you can safely stop taking Suboxone, your doctor will design a tapering schedule to minimize withdrawal symptoms during the transition period.

Potential Suboxone Side Effects

Side effects of Suboxone can occur with both short-term and long-term use. Some stomach discomfort may occur when you first start taking Suboxone, but this should generally dissipate within a few days.

Other potential side effects include the following:

• Blurry vision
• Constipation
• Diarrhea
• Nausea
• Headache
• Insomnia
• Tongue pain
• Mouth numbness
• Backaches

These side effects are rare, so talk to your doctor if you experience them. They are not more common with long-term use, so if you didn’t experience side effects initially, it’s unlikely you will have them down the road.

Should You Stay on Suboxone Long Term?

If Suboxone is helping your recovery, doctors usually recommend staying on it on a long-term basis and even for life if necessary. Suboxone and other medications for OUD (MOUD) reduce the likelihood of relapse.[7]

If you stop taking MOUD and relapse to opioid misuse, you have a high potential for overdose since you haven’t been misusing opioids in a while, and your body may have decreased tolerance to the doses of opioids you were previously taking.

If you take the same amount used before treatment with MOUD, the dose will likely lead to an overdose since your tolerance has declined. Opioid overdose can be fatal.

Issues are more commonly seen with short-term use of Suboxone or MOUD.[3] People who stop using MOUD too soon are more likely to relapse to opioid misuse and experience overdose. Because of this, it’s generally recommended that patients remain on Suboxone as long as needed, even indefinitely, to support their recovery from opioid use disorder.

The prescription medications Suboxone (buprenorphine/naloxone) and Prozac (fluoxetine) can interact and cause health issues. Never take these two medications together without checking with your doctor first.

While Suboxone and Prozac can cause interactions, the U.S. Food and Drug Administration says doctors should approach the issue with care.[7] In the past, some doctors withheld medications like Suboxone in people taking drugs like Prozac. The FDA says the damages associated with untreated opioid use disorder (OUD) are so high that the benefits of combined medications may outweigh the risks. This is especially true because depression is very common among people with OUD, and it is important to treat both conditions in that case.

What Are Prozac & Suboxone?

Before taking any prescription medication, ensure that you understand why it’s prescribed and how it works. Ask your doctor or pharmacist if you’re unsure.

Here’s what you should know about both Prozac and Suboxone:

Prozac

Fluoxetine (or Prozac) is an antidepressant used to treat a variety of conditions, such as these:[2]

• Depression
• Obsessive-compulsive disorder (OCD)
• Bulimia
• Premenstrual dysphoric disorder (PMDD)
• Panic disorder

Prozac belongs to a group of medications known as selective serotonin reuptake inhibitors (SSRIs). Fluoxetine works by increasing the time that serotonin (a special communicating chemical called a neurotransmitter) stays active in the nerves within your central nervous system.

Suboxone

Suboxone contains two ingredients: buprenorphine and naloxone.[3] When combined, they treat opioid use disorder (OUD).

What Is Serotonin Syndrome?

Serotonin is a neurotransmitter involved with regulating behavior, mood, memory and core body functions. Medications like Prozac work directly on the serotonin system, and sometimes, they cause problems.[8]

High levels of serotonin can cause serotonin syndrome, which can be life-threatening. Experts say the true incidence of serotonin syndrome is unknown, as most cases are mild and easily overlooked. Even serious cases might be attributed to some other cause.[9]

However, it’s important to know what serotonin syndrome looks like, as combining Suboxone and Prozac can lead to increased risks.

Researchers say some opioids can increase serotonin levels.[8] Combining these drugs can lead to a buildup of the hormone, and it can cause difficult clinical signs.

Serotonin syndrome can be mild. Out of 46,000 calls to poison control centers due to SSRIs in 2011, only 11 of those cases resulted in death.[5]

However, just in case, you should understand the side effects of serotonin syndrome so you can call your doctor if symptoms appear.[6]

Signs & Symptoms of Serotonin Syndrome

If you believe you are experiencing serotonin syndrome, you must call your doctor. Seek emergency services immediately if your symptoms are severe.

Signs and symptoms of serotonin syndrome may include the following:

• Agitation
• Anxiety
• Restlessness
• Disorientation
• Sweating
• High body temperature
• Fast heart rate
• Nausea
• Vomiting
• Tremors
• Rigid, jerking or overactive muscles
• Dilated pupils
• Dry mucous membranes
• Flushed skin
• Increased bowel sounds

Doctors treat serotonin syndrome by discontinuing your medications and monitoring you until they improve.[4] With prompt care, your problems should fade. This syndrome is temporary and resolved once you discontinue the medications.

If you have any concerns about your medication interactions, talk with your doctor.

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