What is the highest dose of Suboxone?

The dose of Suboxone (buprenorphine/naloxone) that’s most likely to be effective for an average person is 16 mg daily. Sometimes, though, a person will do better with a higher dose , experiencing further reduction in craving or pain. This should be something that is decided in consultation with the prescribing prescriber. Reasons why a person might do better on a higher dose is unclear, but it may have something to do with tolerance or metabolism. Doses as high as 72 mg have been studied for short-term use in hospital settings. However, no added benefits were discovered compared to lower, more typical doses.

How Does Suboxone Dosing Work?

Medications for Addiction Treatment (MAT) have proven very effective at sustaining recovery, and part of MAT involves proper dosing. Your supervising physician will determine the proper medication dosage for you based on various factors, such as these:

• History of opioid use
• Severity of withdrawal symptoms
• Personal characteristics
• Response to treatment so far

Always take Suboxone exactly as prescribed. Your doctor may adjust the dosage of Suboxone you take from your initial prescription based on how effectively the medication works to control withdrawal symptoms and cravings. However, you should never attempt to adjust your Suboxone dosage yourself.

How Is Suboxone Dosed?

Suboxone comes as a sublingual film, meaning it is placed under the tongue when administered. It also comes in pill form.

The filmstrips come in varying dosage levels, with buprenorphine listed as the first ingredient and naloxone as the second. Here are the various strengths available:[1] 

• 2 mg buprenorphine and 0.5 mg naloxone
• 4 mg buprenorphine and 1 mg naloxone
• 8 mg buprenorphine and 2 mg naloxone
• 12 mg buprenorphine and 3 mg naloxone

What Starting Dose Is Recommended for Suboxone? 

The initial recommended dose is up to 8 mg/2 mg of Suboxone in divided doses on the first day.[1] This means you won’t take your Suboxone in a single dose as you will with maintenance treatment. On this first day, you’ll split up the dose throughout the day.

Medical providers will often begin your Suboxone treatment by giving you low-dose variations and assessing their effects. You will most likely  be given a 2 mg/0.5 mg or a 4 mg/1 initial test dose followed by a 2 mg/0.5 or a 4 mg/1 mg dose at least an hour later. You may be assessed after that on the same day to determine if you need a third dose. You’ll continue to be monitored during this initial period.

The recommended doses will depend on the severity of your use, your past history with Suboxone, and your symptoms after the initial test dose.[2] 

The timing of the first dose of Suboxone administration relative to your last use of an opioid will depend on what kinds of opioids you were most recently using. Short-acting opioids, such as heroin, codeine, and hydrocodone, process out of the body more quickly. You’ll begin taking Suboxone 6–12 hours after your last dose of opioids, provided that withdrawal symptoms are present. 

Long-acting opioids, such as methadone, fentanyl, and oxycodone, take longer to process out of the body. As a result, you’ll need to wait longer after your last dose to begin Suboxone. Usually, it’s recommended to wait at least 24 hours after your last dose of a long-acting opioid before taking Suboxone.[3]

How Does Suboxone Dosing Change After the First Day?

On the second day of treatment, your Suboxone dose may be increased from what you received the previous day, to a maximum of 16 mg/4 mg most likely.[1] This 16 mg/4 mg single dose regimen is also the recommended maintenance dose, so if withdrawal symptoms are controlled at this dosage level, you’ll likely remain at this dosage for a while.

Dose Considerations

It may take a few days for your and your medical provider to determine the right dose of Suboxone for you. Your provider will likely have you take your initial doses and then monitor the effects of the medication.

If you continue to experience opioid cravings and withdrawal symptoms after starting Suboxone, your doctor may raise your Suboxone dosage. Once you’ve stabilized on the medication, they may attempt to gradually reduce the dose level again. 

The goal is to keep you balanced and feeling good on Suboxone. And the general recommendation is to keep the Suboxone dosage close to 16 mg/4 mg.[3]

What Is the Highest Dose Prescribed? 

In the early stages of MAT, Suboxone doses of up to 24 mg/6 mg may be prescribed. Suboxone doses above 16 mg/4 mg are generally considered high doses. However, one study showed that people who received more than 16 mg/ 4 mg daily) were less likely to drop out of treatment than those who started on less than 16 mg/4 mg which might imply that higher than standard doses might be more effective early on.[4] Interestingly, participants’ Suboxone dosage toward the end of treatment was not correlated to their likelihood to continue treatment.

How Does Suboxone Dosage Affect Recovery Success? 

An initially higher dose of Suboxone may help to better control withdrawal symptoms and cravings for opioids. As a result, this could encourage patients to stay in treatment and avoid relapse. 

But a higher dose over time isn’t correlated with higher success rates. Because of this, the goal is to reach stability, with withdrawal symptoms and cravings managed, and then taper the Suboxone dose to an average dosing schedule of 16 mg/4 mg. 

Today, most  people will start their Suboxone maintenance dose at around 16 mg/ 4 mg , so a taper back to this level later on is usually not needed.

How Much Suboxone Is Too Much?

When taken as prescribed, it is rare to overdose on Suboxone, although overdoses are possible especially if taken with other sedating medications, like benzodiazepines. If you take much more than prescribed, you may experience some sedation, but even this is rare. 

The general recommendation is to limit daily buprenorphine use to 24 mg. In occasional cases, a provider might suggest someone take up to  32 mg, but the average dose remains 16 mg per day.[5]  

SOURCES

1. Highlights of Suboxone Prescribing Information. Indivior. https://www.suboxone.com/pdfs/prescribing-information.pdf. March 2021. Accessed March 2022. 
2. Emergency Department Buprenorphine/Naloxone (Suboxone): Home Dosing Information. Alberta. https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=custom.ab_suboxone_homedosing_ac_adult. March 2021. Accessed March 2022.
3. Buprenorphine: Quick Start Guide. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf. Accessed March 2022.
4. Treatment Outcomes in Opioid Dependent Patients With Different Buprenorphine/Naloxone Induction Dosing Patterns and Trajectories. American Journal of Addiction. https://pubmed.ncbi.nlm.nih.gov/26400835/. September 2015. Accessed March 2022.
5. Participant Characteristics and Buprenorphine Dose. American Journal of Drug and Alcohol Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272773/. September 2011. Accessed March 2022.