Although the opioid crisis has greatly worsened over the last 20 years, the availability of Suboxone® has become a literal lifesaver for many people. This medication is a combination of buprenorphine and naloxone, and when used properly, it significantly reduces mortality rates associated with opioid use and increases a patient’s chance at treatment success (important safety information).
Using Suboxone properly is the key to success, so missing doses can have harmful effects. This guide explores what happens after missing doses of Suboxone and how to get back on track.
Suboxone dosing information
While the information below offers common dosages and routines, it’s important to note that every individual receives a Suboxone prescription tailored to their specific needs, and that prescription may be different from what you find here. Always take Suboxone exactly as prescribed by your healthcare provider.
Suboxone always comes in a mix that is four parts buprenorphine to one part naloxone. Generally, it comes in a sublingual film that is placed under the tongue, where it dissolves. However, it may also come in a buccal film, meaning it is placed inside the mouth, against the cheek. These films most likely come in one of the following dosages:
- 2 milligrams buprenorphine and 0.5 milligrams of naloxone
- 4 milligrams buprenorphine and 1 milligram of naloxone
- 8 milligrams buprenorphine and 2 milligrams of naloxone
- 12 milligrams buprenorphine and 3 milligrams of naloxone
During the beginning phase of Suboxone treatment, known as induction, doctors prescribe the medication with the intention of managing withdrawal symptoms. This normally means receiving an initial dose of 2 mg buprenorphine/0.5 mg naloxone or 4 mg buprenorphine/1 mg naloxone. No more than 8 mg buprenorphine/2 mg naloxone is given on the first day. After, the doctor will prescribe different strengths of Suboxone to find the right dosage.
After induction, patients are placed on a stable dosage that ranges between 2 mg buprenorphine/0.5 mg naloxone and 24 mg buprenorphine/6 mg naloxone, and this dose should be taken once a day, every day, for as long as treatment continues. It’s always best to take the daily dose at the same time every day, but there is some wiggle room when it comes to timing.
What happens if you miss a day of Suboxone?
If you miss your daily dose or forget to take it at your normal time, there’s no need to panic. Suboxone naturally remains in the body for more than one day, so you’re unlikely to experience negative side effects or a setback in your treatment after missing a single Suboxone dose.
Generally speaking, if someone remembers their forgotten dose within 12 hours of the normal dosing time, it’s okay to take it as normal and adjust accordingly. However, if someone remembers within a few hours of the next scheduled dose, consider the previous dose missed and continue taking your prescription at the normal time and frequency. Never double up or use an extra dose of Suboxone to “make up” for the missed one. Doing so could cause unintended effects or sedation.
What happens after missing multiple doses?
Missing one dose of Suboxone is generally fine, but how many days can you miss Suboxone before it causes a problem? Ideally, you’ll never miss a dose, but it’s bound to happen at some point during a long-term treatment. But avoid missing multiple doses in a row at all costs. One role that Suboxone plays is to occupy and block the opioid receptors in the brain, which keeps cravings at bay. When your body runs out of Suboxone after missing multiple doses (usually after 24-48 hours without medication), you may begin to experience opioid withdrawal, or you may notice cravings returning. Both circumstances put you at risk of relapse, increasing risk of treatment failure or overdose.
Since Suboxone lasts around 36 to 48 hours in the body, you may notice cravings or withdrawals beginning around a day and a half after your last dose. This means that, while missing one Suboxone dose should be safe, missing two or more doses may lead to discomfort. If you notice these symptoms developing and realize that you’ve missed your scheduled doses, take your prescription as soon as possible and continue with treatment as normal.
Contact your Ophelia care team if you have any questions or concerns after a missed dose.
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