Is Suboxone Bad for Your Liver?

No. Healthy people taking Suboxone properly should not have an increased risk of liver toxicity. But if you have underlying liver issues, you may need extra monitoring while you take this Medication for Addiction Treatment (MAT).

What is Suboxone’s Liver Safety Profile?

How Does Suboxone Affect Your Liver?

Your liver processes toxins from your bloodstream. Medications, including Suboxone, pass through the liver before exiting your body.[1] 

Buprenorphine medications like Suboxone are primarily metabolized by the cytochrome P450 system (CYP 3A4). This system’s role is to oxidize toxins or drugs so they can safely be eliminated from the body. However, Suboxone is prescribed in relatively low doses and has rapid metabolism, which reduces its risk of liver damage.[1]

For a person with a healthy liver, Suboxone shouldn’t pose any threat. But for those with past liver damage, it could potentially cause further damage. Because of this, a doctor may perform tests to assess liver function before prescribing Suboxone or other medications.

Suboxone and the Risk of Liver Toxicity

Suboxone is considered a safe and effective medication for the treatment of opioid use disorder (OUD).

However, people with liver damage or pre-existing liver conditions may have an increased risk of liver toxicity when taking Suboxone. One study of patients taking buprenorphine for 28 months found that those with hepatitis C experienced increased levels of liver enzymes, which may indicate damage. That said, the levels were only slightly elevated and not clinically significant, so the researchers concluded that buprenorphine has a low risk of liver damage.[8]

Research also indicates that often, liver damage caused by buprenorphine is due to misusing this medication, such as injecting it. And that hepatitis C is commonly present in Suboxone patients with liver toxicity. After treatment for the infection, many patients are even able to return to taking buprenorphine without issues.[1]

Factors That Impact Suboxone & Your Liver

Before starting Suboxone, tell your doctor if you have liver issues like the ones listed below. Even if you have liver disease, you can usually still take Suboxone safely, but you may need extra medical monitoring to stay safe.[2]

History of Alcohol Misuse

The liver processes each sip of alcohol you take. If you keep drinking, you can harm your liver cells. Drinking alcohol for even a few days can cause a buildup of fats inside the liver. Continued drinking can cause significant scarring.[3]

Alcohol-related liver issues can’t be cured unless you stop drinking for good. If you’re drinking now or you have a history of heavy drinking, tell your doctor. 

Liver Infections

More than 100 million people in the United States are thought to have liver disease.[4] Some have problems caused by alcohol, but others have serious illnesses caused by infections. 

Hepatitis C is one such infection. If you’ve been exposed, your liver could be functioning improperly and taking Suboxone could result in hepatotoxicity (liver toxicity). A simple blood test could help your doctor to spot it. 

Liver Injuries 

Car accidents, gunshots, or car crashes could damage almost every organ in your body, including your liver. People with liver injuries have all sorts of symptoms, including abdominal pain and tenderness.[5] 

If you hurt your liver, the symptoms will likely be obvious. Tell your doctor about what happened.

Advancing Age

Researchers say that liver health declines with age.[6] The older you get, the more likely it is that you will deal with problems like alcoholic liver disease. While older people can and do use medications processed by the liver, it’s a slightly riskier proposition. 

Obesity 

Nonalcoholic fatty liver disease is closely associated with obesity.[7] Researchers say people with obesity have more fat cells circulating in their blood, and they can get collected inside the liver. You may not notice this problem, but your doctor can find out about it through a blood test. 

Ongoing Liver Monitoring for Suboxone Patients

When taking Suboxone for OUD, your doctor will monitor your liver function on an ongoing basis. They will likely conduct liver function tests at least one per year.[9] These tests may include:[10]

• Alanine transaminase (ALT)
• Aspartate transaminase (AST)
• Serum bilirubin
• Alkaline phosphatase (ALP)
• Prothrombin time (PT)
• Gamma-glutamyl transferase (GGT)
• Total protein and albumin

These tests can evaluate patient liver functioning and determine where damage may have occurred, if any.[10]

Typically, liver enzymes continue to be normal or unchanged even with long-term Suboxone use, as long as the person uses this medication as prescribed.[9]

Can You Take Suboxone if You Have Liver Disease?

If you’ve already damaged your liver through infection or injury, you might need additional monitoring. This may include more frequent and comprehensive liver function tests as well as blood work or imaging.

Generally, you can take Suboxone if you have underlying liver disease. However, you should always inform your doctor about your medications and medical conditions before starting Suboxone therapy.