Sublocade vs. Suboxone: What You Should Know

Sublocade (buprenorphine) and Suboxone (buprenorphine/naloxone) are prescription treatments for opioid use disorder. Sublocade is administered by a healthcare provider as an injection, while Suboxone is a dissolvable film placed in the mouth. Suboxone is also available in generic versions.

This piece outlines the primary similarities and differences between Sublocade and Suboxone. For more comprehensive information about each medication, see the detailed articles on Sublocade  and Suboxone .

What side effects can occur with Sublocade and Suboxone?

Below are examples of both mild and serious adverse effects that may happen while using Sublocade or Suboxone.

Refer to the linked in-depth articles for additional side-effect details, or speak with your healthcare provider.

Mild side effects

The table below shows examples of milder side effects reported with Sublocade and Suboxone.

This table may not list every mild side effect. For full information on mild adverse effects, consult the prescribing information for Sublocade  and Suboxone .

Serious side effects

Along with the milder effects above, more serious adverse events can occur with Sublocade or Suboxone. The following table lists serious side effects reported for these medications.

Note: After the FDA approves a medication, it continues to monitor and review reported side effects. To report a side effect from Sublocade or Suboxone to the FDA, visit MedWatch .

What are the dosages and forms of Sublocade and Suboxone?

Sublocade and Suboxone are provided in different dosage forms.

Sublocade is a subcutaneous injection administered by a healthcare professional once monthly. You won’t self-inject Sublocade at home.

Suboxone is a film that you place under the tongue or between the gum and cheek; it dissolves and delivers medication systemically. Suboxone is usually taken once daily.

Your clinician will determine whether you receive Suboxone in their office or whether you can take doses at home.

For more detailed dosing information, see the in-depth articles about Sublocade and Suboxone.

*Sublocade carries a boxed warning about the risk of serious harm if the product is injected into a vein. A boxed warning is the FDA’s strongest safety notice and highlights potentially dangerous drug effects. See the “What are the warnings of Sublocade and Suboxone?” section below for details.

What are Sublocade and Suboxone prescribed for?

Both Sublocade and Suboxone are prescribed for the treatment of opioid use disorder in adults, sometimes called opioid dependence. This condition produces a strong urge to continue using opioid substances despite harmful consequences.

Suboxone may be used at different stages of treatment.

When you stop taking opioids initially, you can experience withdrawal — unpleasant symptoms that occur when the body adjusts to the absence of a substance. During induction (the start of treatment), Suboxone can reduce these withdrawal symptoms. During maintenance (ongoing therapy), Suboxone is taken long term to help control opioid cravings.

Sublocade is used only in the maintenance phase once withdrawal symptoms are controlled. Before beginning Sublocade, you must take another form of buprenorphine (a tablet or film that dissolves under the tongue or inside the cheek) for at least 7 days.

Both medications are intended to be part of a comprehensive treatment plan that includes counseling and other support services.

For additional details about their approved uses, see the full articles on Sublocade  and Suboxone .

What ingredients are in Sublocade and Suboxone?

Both medications contain the active ingredient buprenorphine, which belongs to a class known as partial opioid agonists. These drugs act in a way similar to opioids but with different effects.

Suboxone also includes naloxone, an opioid antagonist that blocks the effects of opioids.

FAQ about Sublocade and Suboxone

Answers to common questions about Sublocade and Suboxone are provided below.

Can I use Sublocade and Suboxone at the same time?

No. Your prescriber will not give both medications concurrently. They are used in different stages of treatment for opioid use disorder.

Both contain buprenorphine, so taking them together could raise the chance of side effects and could potentially lead to overdose.

You may transition from Suboxone to Sublocade as part of your treatment. See the “Can I switch between Sublocade and Suboxone?” section for more on switching.

If you have questions about using these drugs together, discuss them with your clinician.

Will I experience withdrawal if I stop Sublocade or Suboxone?

Yes, stopping Sublocade or Suboxone can produce withdrawal symptoms because both can cause physical dependence — the body adapts and must readjust without the medication.

Withdrawal symptoms may include:

• abdominal pain
• diarrhea, nausea, or vomiting
• muscle aches
• runny nose
• shaking
• increased sweating

With Sublocade, withdrawal may not appear until months after the last injection because the drug can remain in the body for about a year or longer. With Suboxone, withdrawal symptoms may occur within days of stopping the medication.

Do not stop treatment unless your provider advises you to. When discontinuing Suboxone, clinicians usually taper the dose gradually to lessen withdrawal severity.

After the final Sublocade injection, your provider will monitor you for several months for signs of withdrawal. If withdrawal occurs, they may prescribe a short course of a different buprenorphine formulation that dissolves under the tongue or inside the cheek.

If you notice withdrawal after stopping either medication, notify your clinician promptly. They can recommend medications or other strategies to manage symptoms.

Can I take pain medications while on Sublocade or Suboxone?

Sometimes, yes.

Generally, you should avoid using opioid pain relievers while on Sublocade or Suboxone because combining them can increase the risk of respiratory depression (slowed breathing), which can be life-threatening.

Non-opioid analgesics like acetaminophen (Tylenol) and NSAIDs such as ibuprofen (Advil) are preferred for pain relief.

If you unexpectedly need opioid analgesia (for example, for surgery or an emergency), inform the treating clinicians that you are taking Sublocade or Suboxone so they can closely monitor your breathing.

Can Sublocade or Suboxone cause breathing difficulties?

Yes. High doses of Sublocade or Suboxone can cause respiratory depression. Breathing problems were not seen in preapproval studies for Sublocade  or Suboxone , but such events have been reported since they became available.

These drugs can also contribute to sleep-related breathing issues, like sleep apnea and reduced blood oxygen during sleep.

Your risk of breathing problems is higher if you have lung disease (such as asthma or COPD). Using alcohol or certain other medications alongside Sublocade or Suboxone can also increase risk; examples include:

• opioids such as oxycodone or hydromorphone
• benzodiazepines such as alprazolam  (Xanax) and diazepam  (Valium)
• sleep aids such as eszopiclone (Lunesta) and zolpidem (Ambien)

Unless your clinician advises otherwise, avoid alcohol and these medications while on Sublocade or Suboxone. You may also need to avoid them for months after your last Sublocade injection because Sublocade can remain in your system for over a year.

Severe breathing problems are medical emergencies and can lead to coma or death. If you have difficulty breathing while taking Sublocade or Suboxone, call 911 or your local emergency number immediately.

Discuss your individual risk for breathing issues with your provider.

Can Sublocade or Suboxone lower hormone levels?

Yes. Use of Sublocade or Suboxone for more than one month may suppress adrenal production of the hormone cortisol, a condition called adrenal insufficiency .

Symptoms of adrenal insufficiency can include:

• extreme tiredness
• diarrhea, nausea, or vomiting
• loss of appetite
• depression
• unintended weight loss
• low blood pressure

If you experience any of these symptoms while taking Sublocade or Suboxone, tell your clinician. They may order a cortisol test to check blood cortisol levels. If cortisol is low, your clinician may prescribe corticosteroids such as prednisone to restore levels.

What do Sublocade and Suboxone cost?

Cost can be a consideration whether or not you have health insurance. You can visit Optum Perks* for estimated prices and coupons for Suboxone. Note that Optum Perks coupons typically cannot be combined with insurance copays or benefits.

What you pay for either medication depends on your treatment plan, insurance coverage, and the pharmacy used. It may also include the cost of visits to your healthcare professional.

Both Sublocade and Suboxone are brand-name products; Suboxone also has a generic buprenorphine/naloxone option. Brand-name medications generally cost more than generics. If you’re interested in a generic Suboxone alternative, discuss it with your provider.

*Optum Perks is affiliated with HealthEH.

Optum Perks is owned by RVO Health. By following the link, we may receive a commission. Learn more.

How well do Sublocade and Suboxone work?

Both Sublocade and Suboxone have been shown to be effective treatments for opioid use disorder. Buprenorphine—the active ingredient in both products—is recommended by the American Society of Addiction Medicine as a treatment option for this condition.

For study details and clinical data, see the prescribing information for Sublocade  and Suboxone .

Keep in mind that individual results may vary. Discuss with your clinician whether one of these medications is appropriate for you.

What warnings should I know about for Sublocade and Suboxone?

There are specific precautions and warnings for these medications. Some warnings overlap, while others are unique to one drug. Review these with your provider before starting treatment.

Speak with your clinician to determine whether any of the following warnings apply to you.

Boxed warning for Sublocade: Serious harm or death if injected into a vein

Sublocade carries a boxed warning , the FDA’s most serious safety communication. It alerts clinicians and patients to potentially dangerous effects.

Sublocade must not be injected into a vein. After injection under the skin, the formulation becomes a solid mass. If the product enters the bloodstream, the solid mass could travel and obstruct blood flow to vital organs.

For safety, Sublocade should only be administered subcutaneously by a qualified healthcare professional. This reduces the chance of incorrect injection.

Sublocade is available only through the Sublocade REMS (risk evaluation and mitigation strategy) program. Only healthcare providers certified in this REMS can obtain, prescribe, and administer Sublocade. The medication is a controlled substance due to the potential for misuse and dependence.

Locations that provide Sublocade must also be REMS-certified.

For more information, consult your clinician, visit the Sublocade REMS website, or call 866-258-3905.

Other warnings

Beyond the boxed warning above, Sublocade and Suboxone share other cautions.

Before starting either medication, tell your clinician if you have any of the following conditions or factors:

• an abnormal heart rhythm
• underactive adrenal glands
• a known allergy to either medication or their ingredients
• pregnancy* or breastfeeding
• a lung disorder such as asthma or chronic obstructive pulmonary disease (COPD)
• liver disease, such as hepatitis
• a current or recent head injury or brain disorder
• gallbladder disease

For more on these drugs, see the full articles on Sublocade  and Suboxone .

*Use of Sublocade or Suboxone during pregnancy may result in neonatal opioid withdrawal syndrome in newborns. Discuss risks and benefits with your clinician.

Can I switch between Sublocade and Suboxone?

Short answer: Yes.

Details: Before starting Sublocade injections, you must take another buprenorphine formulation for at least 7 days (a buprenorphine product that dissolves under the tongue or inside the cheek).

Suboxone is an example of such a formulation, so you may transition from Suboxone to Sublocade after seven days of Suboxone treatment.

You can also move from Sublocade to Suboxone, but you will likely need to wait until it’s nearly time for your next Sublocade injection, since Sublocade can remain in the body for an extended period.

Your clinician will determine the appropriate timing for any switch between these medications.

Reminder: Do not change or stop your medication without your clinician’s guidance.

Questions to ask your clinician

Both Sublocade and Suboxone are effective options for treating opioid use disorder. If you’re unsure which medication is right for you, talk it over with your clinician.

Consider asking your clinician:

• Am I at increased risk for side effects from Sublocade or Suboxone?
• If both are appropriate for me, what factors would make you choose one over the other?
• Are there interactions between these medications and my current prescriptions?
• Is one of these medications more likely to be covered by my insurance?

Ask a pharmacist

Q:

I’ve been on Sublocade for several months. Lately my opioid cravings return during the week before my next injection. Should I consider switching to Suboxone?

A:

If you feel your Sublocade dose wears off too soon, discuss options with your clinician. They may order blood testing to check medication levels, which can help determine whether switching makes sense. If appropriate, you might be transitioned from Sublocade to Suboxone.

To move from Sublocade to Suboxone, your Sublocade blood concentration must fall below a certain threshold. Your clinician will advise on the right timing for a switch.

Disclaimer: Every effort has been made to ensure the information here is accurate, complete, and current. This article is not a substitute for professional medical advice. Always consult a licensed healthcare provider before starting, stopping, or changing any medication. Drug information is subject to change and may not cover all uses, instructions, precautions, interactions, allergic reactions, or adverse effects. The absence of warnings for a particular drug does not mean it is safe or appropriate for all patients or uses.