Suboxone vs. Naltrexone

Suboxone is a brand-name medication that contains two drugs: buprenorphine and naloxone. Buprenorphine is classified as an opioid partial agonist-antagonist. Naloxone is classified as an opioid antagonist.

Naltrexone is a generic medication. Naltrexone is classified as an opioid antagonist, similar to the naloxone contained in Suboxone.

Uses

Suboxone is FDA-approved to treat opioid dependence. This includes both the induction phase and the maintenance phases of treatment.

During the induction phase, the drug decreases withdrawal symptoms while you stop or reduce opioid use. During the maintenance phase, the drug keeps withdrawal symptoms and cravings in check as you complete your drug abuse treatment program.

Naltrexone is also approved to treat opioid dependence. However, it’s only approved for preventing relapse in people who have completely stopped abusing opioids.

Forms and administration

Suboxone comes as an oral film that can be used under your tongue (sublingual) or between your gums and your cheek (buccal).

Naltrexone comes as an oral tablet.

Effectiveness

A 2016 clinical study found that Suboxone was more effective for reducing opioid use than naltrexone over 12 weeks.

Side effects and risks

Suboxone and naltrexone have some similar side effects, and some that differ. Below are examples of these side effects.

Suboxone and NaltrexoneSuboxoneNaltrexone
More common side effectsinsomnia (trouble sleeping)anxietystomach pain or upsetnauseavomitingconstipationweakness or fatigueheadachedepressiondizzinesschillsopioid withdrawal symptomssweatingcoughfeverrunny nosesore throatdiarrheaback painloss of appetitemuscle painthirstirritabilitydelayed ejaculation (in men)rash
Serious side effectsliver damagesevere withdrawal symptomssevere allergic reactionabuse and dependencebreathing problems and comahormone problems (adrenal insufficiency)severe depression and thoughts of suicide

Costs

Suboxone is a brand-name drug. It’s also available in a generic version. Generic versions often cost less than brand-name drugs.

Naltrexone oral tablet is a generic drug. It’s not available as a brand-name drug. (However, naltrexone also comes as extended-release injection. This form is only available as the brand-name drug Vivitrol [see above].)

Naltrexone usually costs less than brand-name or generic Suboxone. The actual amount you pay will depend on your insurance.

Suboxone and alcohol

You should not drink alcohol if you’re taking Suboxone.

Consuming alcohol with Suboxone can increase your risk of dangerous side effects, such as:

  • trouble breathing
  • low blood pressure
  • excessive sleepiness
  • coma

Suboxone interactions

Suboxone can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Suboxone and other medications

Below is a list of medications that can interact with Suboxone. This list does not contain all drugs that may interact with Suboxone.

Before taking Suboxone, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Benzodiazepines

Taking Suboxone with benzodiazepines can increase the risk of severe side effects such as severe sedation (sleepiness), breathing problems, coma, and death.

Examples of benzodiazepines include:

  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • midazolam

Drugs that block metabolism of Suboxone

Certain medications that block an enzyme called cytochrome P450 3A4 (CYP3A4) can decrease how fast the body breaks down Suboxone. Taking these drugs with Suboxone can increase the risk of side effects.

Examples of these medications include:

  • erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin)
  • fluconazole (Diflucan)
  • itraconazole (Sporanox)
  • ketoconazole
  • HIV protease inhibitors, such as atazanavir (Reyataz) and ritonavir (Norvir)

Drugs that increase metabolism of Suboxone

Certain medications make an enzyme called cytochrome P450 3A4 (CYP3A4) more active and can increase how fast the body breaks down Suboxone. This can make Suboxone less effective.

Examples of these medications include:

  • carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
  • phenobarbital
  • phenytoin (Dilantin, Phenytek)
  • primidone (Mysoline)
  • rifampin (Rifadin)

Serotonergic drugs

Taking Suboxone with medications that increase serotonin levels in your body might increase your risk of developing serotonin syndrome, a drug reaction that can be dangerous.

Examples of medications that increase serotonin levels include:

  • antidepressants, such as:
    • selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil, Pexeva, Brisdelle), and sertraline (Zoloft)
    • serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
    • tricyclic antidepressants such as amitriptyline, desipramine (Norpramin), and imipramine (Tofranil)
    • monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and selegiline (Emsam, Eldepryl, Zelapar)
  • certain opioids such as fentanyl (Fentora, Abstral, others) and tramadol (Ultram, Conzip)
  • buspirone, an anxiety medication
  • monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), linezolid (Zyvox), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate)

Anticholinergic drugs

Anticholinergic drugs block the action of a chemical messenger called acetylcholine. Taking these drugs with Suboxone might increase the risk of side effects such as constipation and urinary retention. Examples of these drugs include:

  • fesoterodine (Toviaz)
  • oxybutynin (Gelnique, Ditropan XL, Oxytrol)
  • scopolamine (Transderm Scop)
  • tolterodine (Detrol)

Suboxone and Xanax

Xanax (alprazolam) is classified as a benzodiazepine. Taking Suboxone with benzodiazepines, including Xanax, can increase the risk of severe side effects. These include severe sedation (sleepiness), breathing problems, coma, and death.

Suboxone and tramadol

Taking tramadol (Ultram, Conzip) with Suboxone can increase the risk of side effects such as serotonin syndrome and decreased breathing. Suboxone may also make tramadol less effective for treating pain.

Suboxone and Adderall

There are no known interactions between Adderall (amphetamine and dexamphetamine salts) and Suboxone.

Suboxone and Klonopin

Klonopin (clonazepam) is classified as a benzodiazepine. Taking Suboxone with benzodiazepines, including Klonopin, can increase the risk of severe side effects. These include severe sedation (sleepiness), breathing problems, coma, and death.

Suboxone and gabapentin

There are no known interactions between gabapentin (Neurontin) and Suboxone.

Suboxone and anesthesia

Suboxone and anesthesia used for surgery may interact and increase your risk of serious side effects. Before having surgery, talk with your doctor about your treatment with Suboxone. You may need to temporarily stop taking Suboxone.

Suboxone and Ambien

Taking Suboxone with Ambien (zolpidem) can increase the risk of severe side effects. These include severe sedation (sleepiness), breathing problems, coma, and death.

Suboxone and codeine

Taking codeine with Suboxone can increase the risk of side effects such as decreased breathing. Suboxone may also make codeine less effective for treating pain.

Suboxone and herbs and supplements

Suboxone can interact with certain supplements or herbs you may be taking.

Herbs and supplements that affect serotonin

Supplements that affect serotonin levels can increase your risk of developing serotonin syndrome.

Examples of these supplements include:

  • 5-HTP
  • garcinia
  • L-tryptophan
  • St. John’s wort