How to Start Taking Buprenorphine
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Confirm you are in withdrawal
Because it is strong and blocks other opioids, like heroin or fentanyl, the first dose of buprenorphine cannot be taken soon after a dose of other opioids, or it may cause sudden withdrawal, called “precipitated withdrawal.” That is why we wait for withdrawal before taking the first dose of buprenorphine.
Before taking your first dose:
Wait at least 12 hours from your last dose of heroin, fentanyl or opioid pain pills (Vicodin, oxycodone, Percocet, etc), or at least 72 hours since your last dose of methadone.
AND
Confirm that you are experiencing withdrawal and are therefore ready to begin taking buprenorphine. You should be ready to take your first dose if you are having at least 3 of these withdrawal symptoms:
- Chills
- Goosebumps
- Stomach cramps
- Nausea
- Sweating
- Teary eyes
- Runny nose
- Large pupils
- Diarrhea
- Body aches or bone aches
- Restlessness
- Yawning
- Anxiety
- Muscle cramps
Start taking your medication (Day 1)
If you take films, follow the same instructions as below and remember to cut your film in half where it says to split a tablet in half.
If you’ve confirmed you are in withdrawal, take your first dose of 4mg (half of an 8mg tablet/film) of buprenorphine by placing it under your tongue and allowing it to dissolve for 15 minutes without swallowing.
Starting with a smaller dose like 4mg is safest—if you were to “precipitate withdrawal” by taking the medicine too early, this will be milder and pass more quickly than with a larger dose.
Wait 1-2 hours.
If you are still feeling sick (having symptoms of withdrawal) after 1–2 hours, take another 4mg (half a tablet/film).
Now you've taken 8mg total (one tablet/film).
Wait 1-2 hours.
If you are still feeling sick (having symptoms of withdrawal) after 1–2 hours, take another 4mg (half a tablet/film).
Now you've taken 12mg total (one and a half tablets/films).
Wait 1-2 hours.
If you are still feeling sick (having symptoms of withdrawal) after 1–2 hours, take a FINAL 4mg (half a tablet/film).
Now you've taken 16mg total (two tablets/films).
Continue taking your medication (Day 2 onward)
On each following day, take the same total dose that you took on day 1 (up to 16mg).
- If you took 16mg, continue taking 16mg daily until your follow up visit.
- If you took less than 16mg on day 1, and are still craving or in withdrawal, add another 4mg and see if this helps.
Do not take more than 16mg (two tablets/films) per day until your next visit with your Clinician. In the next few days, you will have a follow up visit with your Clinician where you’ll discuss your current dosage, and adjust it according to your needs.
Questions, concerns, or feedback?
You can send a message to your Care Team in the app with non-urgent questions or feedback, or you can always call Boulder's 24/7 Support at 888-316-0451.