There seem to be so many manufacturers of buprenorphine/naloxone. Does it matter which one you get?
Buprenorphine/naloxone basics
Many people who are dependent on or addicted to opioids desperately want to stop using them … but they need help. Opioids are physically and psychologically addicting, so stopping their use leads to physical withdrawal symptoms that can be intense and miserable, as well as cravings that can be difficult to withstand. Buprenorphine is an effective tool in recovering from opioid use disorder because it relieves cravings and withdrawal symptoms so that individuals have the opportunity to heal and establish stability.
How does buprenorphine do this? It’s an opioid itself, but it’s a kind called a partial opioid agonist. This means that although it bonds with the opioid receptors in the brain, it doesn’t fully activate them. This partial activation allows buprenorphine to provide relief from cravings and opioid withdrawal symptoms without creating the euphoria or the drive to take more that characterize the use of opioids like heroin, fentanyl, oxycodone, and morphine.
Suboxone and other buprenorphine/naloxone medications also include another medication: naloxone. Naloxone does not activate opioid receptors at all, but it is very good at bonding to them and blocking them off so that opioids can’t stimulate them. So why is it in a medication alongside an opioid? It’s a safety measure. Buprenorphine is effective when dissolved in the mouth, but not when swallowed (which is why Suboxone is dissolved under the tongue or against the inside of the cheek). Naloxone, on the other hand, is effective when snorted or injected, but not when dissolved in the mouth. So if buprenorphine/naloxone is taken as directed, the buprenorphine works while the naloxone does nothing. If the buprenorphine is misused (taken incorrectly in an attempt to get high), the naloxone goes into effect and blocks the buprenorphine.
Does it matter if I take a generic or the name-brand Suboxone?
In order to be approved by the FDA, the manufacturer of a generic medication has to show that the drug:
- is the same type of product as the brand name, with the same time-release technology.
- is made correctly and consistently.
- has exactly the same active ingredient as the brand-name drug.
- has the same bio-availability as the brand-name version—the body processes it the same way.
- has safe inactive ingredients.
- is stable over its shelf-life.
With all of that regulation, you would think that generic drugs would affect every person in exactly the same way as the brand name medication they are based on. And for many people, they do! But sometimes the inactive ingredients (fillers, flavorings, and dyes) can make one version of a medication more or less effective for an individual than another version—even with identical active ingredients. Note that this isn’t the same for everyone; a name brand might work better for one person, while a particular generic brand might work better for someone else. If you switch to a different manufacturer, pay close attention to how your body reacts, and keep your provider informed.
Can my doctor specify a particular manufacturer?
If you find that a particular manufacturer’s formulation works better for you than others, you can request that your provider specify a particular manufacturer when prescribing. But many insurance plans will not cover name-brand medications when a generic exists. So if you prefer Suboxone or Zubsolv over the generic options, you may have to pay out of pocket to get them. Additionally, a pharmacy is not required to abide by the request for a particular manufacturer’s generic, especially if it’s not one that they usually carry.
If you find that the name brand works significantly better for you but your insurance won’t cover it, talk to your provider. They may be able to help you request a prior authorization for the name-brand medication. If a particular generic works best for you, you may need to do some footwork, calling around to various pharmacies in your area to see if they stock the generic you prefer.
Let’s take a quick look at some of the buprenorphine/naloxone options you might encounter. Note that we’re not including medications that are buprenorphine-only (like Subutex) on this list.
Name-brand buprenorphine/naloxone
Suboxone
Suboxone is the oldest and best-known brand name of buprenorphine/naloxone. In fact, a lot of people use “Suboxone” when referring to any of these medications. Suboxone tablets (no longer available) were approved for sale in 2002, and the sublingual films were approved in 2010.
- Form: Sublingual films
- Dosage strengths:
- buprenorphine 2 mg/ naloxone 0.5 mg
- buprenorphine 4 mg/ naloxone 1 mg
- buprenorphine 8 mg/ naloxone 2 mg
- buprenorphine 12 mg/ naloxone 3 mg
- Manufacturer: Indivior (previously Reckitt Benckiser Pharmaceuticals)
- Flavor: Suboxone is lime-flavored. Read more about managing the taste in our post, Suboxone Tastes Bad: Tips to Cope With the Flavor.
- Important note: Because it is a name-brand medication, Suboxone is often non-preferred or not covered by prescription drug plans through insurers when generics are available.
Zubsolv
Zubsolv is also a brand name buprenorphine/naloxone. When Zubsolv was approved by the FDA in 2013, there were only two dosages available (5.7mg/1.4mg and 1.4mg/0.36mg), but more have been added since then.
- Form: Sublingual tablets
- Dosage strengths:
- buprenorphine 0.7 mg /naloxone 0.18 mg
- buprenorphine 1.4 mg /naloxone 0.36 mg
- buprenorphine 2.9 mg /naloxone 0.71 mg
- buprenorphine 5.7 mg /naloxone 1.4 mg
- buprenorphine 8.6 mg /naloxone 2.1 mg
- buprenorphine 11.4 mg /naloxone 2.9 mg
- Manufacturer: Orexo
- Flavor: Minty, menthol flavor
- Important note: Like Suboxone, Zubsolv is a brand-name medication and is therefore often non-preferred or not covered by prescription drug plans through insurers when generics are available.
Generic buprenorphine/naloxone
Dr. Reddy’s
Dr. Reddy’s generic buprenorphine/naloxone was one of the earliest generic options for buprenorphine/naloxone. It was approved by the FDA in 2018 and relaunched in 2019 after a court case brought by Suboxone’s manufacturer Indivior.
- Form: Sublingual films
- Dosage strengths:
- buprenorphine 2 mg/naloxone 0.5 mg
- buprenorphine 4 mg/naloxone 1 mg
- buprenorphine 8 mg/naloxone 2 mg
- buprenorphine 12 mg/naloxone 3 mg
- Manufacturer: Dr. Reddy’s
- Flavor: Lemon-lime
Alvogen
- Form: Sublingual films
- Dosage strengths:
- buprenorphine 2 mg/naloxone 0.5 mg
- buprenorphine 4 mg/naloxone 1 mg
- buprenorphine 8 mg/naloxone 2 mg
- buprenorphine 12 mg/naloxone 3 mg
- Manufacturer: Alvogen
- Flavor: Lime
Aveva
Recently approved in 2022, Aveva is another generic sublingual film.
- Form: Sublingual films
- Dosage strengths:
- buprenorphine 8 mg/naloxone 2 mg
- buprenorphine 12 mg/naloxone 3 mg
- Manufacturer: Aveva
- Flavor: Lemon-lime
Viatris
- Form: Sublingual films
- Dosage strengths:
- buprenorphine 2 mg/naloxone 0.5 mg
- buprenorphine 4 mg/naloxone 1 mg
- buprenorphine 8 mg/naloxone 2 mg
- buprenorphine 12 mg/naloxone 3 mg
- Manufacturer: Viatris (previously Mylan)
- Flavor: Lemon-lime
Rhodes Pharmaceuticals
- Form: Sublingual tablets
- Dosage strengths:
- buprenorphine 2 mg/naloxone 0.5 mg
- buprenorphine 8 mg/naloxone 2 mg
- Manufacturer: Rhodes Pharmaceuticals
- Flavor: Lemon
Mallinckrodt/SpecGX
- Form: Sublingual tablets
- Dosage strengths:
- buprenorphine 2 mg/naloxone 0.5 mg
- buprenorphine 8 mg/naloxone 2 mg
- Manufacturer: Mallinckrodt/SpecGX
- Flavor: Lemon
That was a long list! As you navigate your recovery, pay attention to how you respond to different formulations and manufacturers of buprenorphine/naloxone. Some people find that they all work the same, while others have firm preferences for films over tablets or one flavor over another. Some folks even have reactions to certain brands. Keep your provider looped in on what you experience, so they can help you find the options that are best for you.