Macrodose transition instructions
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The macrodose method is one way to start buprenorphine-naloxone (the medicine in Suboxone). With this method, you wait until you're in withdrawal, then start with a larger first dose. Starting too soon can cause sudden, more severe withdrawal, so waiting helps you avoid that.
- Pros: The larger first dose eases withdrawal quickly. The wait is shorter than the standard method, about 12 hours.
- Cons: You still need to go through some withdrawal before your first dose.
Medicines to help you feel more comfortable
Your clinician may have prescribed premedications to help with symptoms like anxiety, restlessness, muscle discomfort, nausea, or vomiting. Take them as your clinician recommended.
When to take your first dose
You can start once it's been at least 12 hours since you last used and you have at least 3 of these symptoms:
- Restlessness
- Heavy yawning
- Large pupils
- Runny nose
- Body aches
- Tremors or twitching
- Chills or sweating
- Feeling anxious or irritable
- Goosebumps
- Stomach cramps, nausea, vomiting, or diarrhea
Day 1
- Once you're in withdrawal, place 2 films or tablets (16 mg) of buprenorphine-naloxone under your tongue and let them dissolve completely.
- If you still have significant withdrawal symptoms 30 minutes to 1 hour later, place 1 more film (8 mg) under your tongue.
Day 2 and after
Take your full daily dose of 2 to 3 films or tablets (16 to 24 mg). You can take it all in the morning or split it up through the day, like morning, afternoon, and evening.
What happens next
At your next visit, you and your clinician will work together to find the right daily dose for you. Most people take between 16 and 24 mg a day.
The goal is for you to feel like your usual, healthy self. If your dose is too low, you may feel withdrawal between doses. If it's too high, you may feel sleepy and slow. The right dose can change slowly over time as your body adjusts to daily treatment.
If something doesn't feel right
If you're having a hard time with withdrawal, or anything worries you, call 888-316-0451 or message your care team right away. You don't have to wait for your next visit. If Boulder is closed, you can still reach an on-call medical provider 24/7 at the same number.