Tapering off Suboxone involves gradually using smaller amounts of medication until you’re taking none at all.

If you’re ready to stop taking your medication for opioid use disorder, consult your provider. They will create an individualized Suboxone tapering schedule for you and show you how to wean off this medication safely and effectively.

Remember that plenty of people stay on Suboxone indefinitely, so you don’t have to taper off it if it continues to support your long-term recovery efforts.

Why Consider a Suboxone Taper?

Suboxone is safe for long-term use, and some people take the medication open-endedly to keep their opioid use disorder (OUD) under control.[1]

These are three reasons people cite when requesting a Suboxone taper, including:

• Your OUD is under control: Your opioid cravings are gone, you’ve been in recovery for many years, and you don’t think you need medication.
• You’re dealing with side effects: While most people tolerate Suboxone well, some patients will have persistent bothersome side effects, including nausea, GI upset, dizziness, sexual dysfunction, or headaches.

Know that you’re not required to quit taking medication that helps you. But if you’re ready to quit, your provider can help you plan.

Individualized Approach to Buprenorphine and Suboxone Tapering

While research suggests that longer treatment periods are generally beneficial, it is important to remember that everyone is different.

Factors to Consider When Tapering Buprenorphine or Suboxone

If you are considering tapering off buprenorphine or Suboxone, it is important to talk to your provider. They can help you assess your individual risk factors and make a plan that is right for you.

Some factors that your provider may consider include:

• Your history of opioid use
• Your severity of OUD
• Your response to treatment
• Your goals for recovery
• Your support system
• Your mental health

How Long Does it Take to Taper Off Suboxone?

There is no one-size-fits-all Suboxone tapering schedule—everyone’s body, physiology, symptoms, and mental health are different.

Your Suboxone taper schedule will depend on many things, such as:

• Your current Suboxone dose
• How long you’ve been taking Suboxone for OUD
• Any tapering history you have
• The emergence of withdrawal symptoms or cravings
• How you feel on lower doses
• Your individual physiology
• Your mental health

What Are the Risks of Quitting Suboxone?

Before you think of quitting, consider whether or not you’re truly ready to do so. Talk to your treatment team and support network to assess whether it’s the best decision for your long-term recovery.

There is no shame in taking Suboxone for long periods or even indefinitely when necessary. Addiction is a chronic, relapsing condition. If your medication helps you stay in recovery, keep taking it.

These are a few known risks of quitting Suboxone:

Withdrawal Symptoms

Opioid withdrawal symptoms are not usually life-threatening, but they can be extremely uncomfortable. They can cause people to relapse toward repeated drug use to ease the painful symptoms. And if you take too large a dose when you relapse, this could be fatal.

If you quit taking Suboxone too rapidly, you could develop uncomfortable symptoms like nausea and vomiting.

Relapse

Using Suboxone for longer periods of time is associated with a better chance of recovery.[4] The medication alleviates chemical imbalances in your brain, allowing you to focus on your recovery. Each dose helps you to avoid discomfort and cravings, making you less likely to relapse.

If opioid cravings become overwhelming, some people turn to street drugs like heroin rather than medications like Suboxone. But one slip could lead to a life-threatening overdose.

How to Decide if a Taper Is Right for You

Your provider can be especially helpful in discussing why you want to taper off Suboxone. If you want to quit because of difficult side effects, your provider could suggest a different formulation or dose. You could still get the help you need without abandoning a medication that is helping to keep you from relapse.

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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