Signs Your Suboxone Dose May Be Too Low

Persistent opioid withdrawal or cravings while taking Suboxone can mean your treatment plan needs review. A dose that is too low is one possibility, but symptoms alone cannot establish the cause.

Do not increase the dose yourself. Contact the prescriber and explain what is happening, when it happens, and how you are taking the medication.

Symptoms to report

Possible withdrawal symptoms include sweating, runny nose, yawning, restlessness, aches, nausea, diarrhea, and sleep disruption. Cravings, continued nonprescribed opioid use, or difficulty functioning also deserve attention. SAMHSA TIP 63: Medications for opioid use disorder

Tell the clinician if symptoms repeatedly return before the next prescribed dose or if they never become adequately controlled.

These symptoms are not specific to underdosing. Illness, anxiety, other medication changes, missed doses, or starting buprenorphine too early can produce a different problem that needs a different response.

The first days require special care

A sudden worsening soon after an initial buprenorphine dose may be precipitated withdrawal. That is different from ordinary breakthrough symptoms during stable treatment.

Contact the clinician promptly for guidance. Recent fentanyl or long-acting opioid use can make initiation more complicated, so do not rely on a fixed waiting period or another person's dosing plan. FDA Suboxone prescribing information

There is no universal “small” or “large” dose

The goal is adequate control of withdrawal and cravings while supporting functioning and avoiding problematic side effects.

FDA has clarified that dosing should be individualized and that doses above 24 mg of buprenorphine per day may be appropriate for some patients. This is not an instruction to increase your own prescription. FDA: Individualized buprenorphine maintenance doses

A clinician considers response, opioid exposure, tolerability, and other factors.

Prepare for a useful medication review

Bring a short record of symptoms and their timing. Include missed doses, any swallowing of film before it dissolved, recent opioid use, and all other medicines and substances.

Also explain sleep, pain, stress, and barriers to obtaining medication. Treatment problems are easier to address when the clinician has the complete picture.

Suboxone film should be used whole as directed. Injectable buprenorphine products are different medicines, not injectable Suboxone.

What if the dose seems too strong?

Excessive sedation, confusion, or impaired functioning also require review. Inability to wake or slow or abnormal breathing is an emergency: call 911 and give naloxone if available. CDC: Responding to an overdose

Do not combine Suboxone with alcohol. Prescribed sedatives require coordination rather than abrupt, unsupervised changes.

The goal is stability

Effective treatment does not require reaching the lowest imaginable dose or completing a mandatory taper. Ongoing medication can be appropriate for years. CDC: Treating opioid use disorder

A review can lead to a dose adjustment, a change in timing or formulation, additional support, or investigation of another cause. Asking for help with persistent symptoms is part of treatment.

Start Suboxone treatment online. You can see one of our Suboxone doctors online, by video. The first visit is $89. Follow-up visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and medication is priced separately.