Suboxone or Subutex? which one is good for you in pregnancy?
Subutex and Suboxone are two drugs that are frequently administered to people who are trying to overcome an opiate addiction. The US Food and Drug Administration (FDA) has approved both therapeutic options for the treatment of opioid use disorder (OUD).
The key difference between Subutex and Suboxone is that the former does not contain naloxone, which was thought to increase the chance of miscarriage or bad fetal outcomes when first introduced. Suboxone, which does contain naloxone, appears to be equally safe and effective as Subutex, according to study. Pregnancy and Addiction Treatment Medication
Methadone was the standard of care in combination with counseling and behavioral therapy when Medication for Addiction Treatment (MAT) became the accepted protocol for pregnant women diagnosed with OUD. Methadone must be delivered in a licensed opioid treatment program in the United States.
In later years, buprenorphine pharmacotherapy was shown to be comparable to methadone in terms of efficacy and safety, although buprenorphine therapies have gained in popularity faster because to their convenience and ease of administration.
According to new research, buprenorphine treatment causes less severe Neonatal Abstinence Syndrome than methadone treatment.
In terms of overdose risk, buprenorphine drugs are likewise thought to be safer than methadone.
Subutex, the brand name for buprenorphine monotherapy, and Suboxone, the brand name for buprenorphine coupled with naloxone, are the two most well-known buprenorphine formulations.
Buprenorphine monotherapy is generally referred to as Subutex. It is a drug that is both safe and effective in the treatment of OUD.
Patients who are pregnant, have significant liver illness, or have a proven naloxone allergy are frequently prescribed the drug.
Buprenorphine is a partial opioid, as opposed to complete opioids such as oxycodone, heroin, or fentanyl. By occupying opioid receptors in the brain, buprenorphine decreases cravings and prevents withdrawal.
Because buprenorphine is a partial opioid, it has a ceiling effect, which means that beyond a certain dose, there is no more opioid action, lowering the danger of overdose. After sublingual administration (through films under the tongue), which is the most usual method for Subutex treatment, Subutex inhibits opioid receptors in the brain for about 31 to 35 hours.
What Is Suboxone and How Does It Work?
Suboxone is a brand-name medicine that combines buprenorphine and naloxone and is often prescribed by professionals to treat opioid use disorder. While buprenorphine works as a partial opioid, suppressing cravings and lowering the risk of overdose, naloxone (also known as Narcan) works as an opioid antagonist, blocking opioids in the brain.
The combination of buprenorphine and naloxone reduces the likelihood of buprenorphine being misused. Suboxone stays in the system for 28 to 42 hours following sublingual (under the tongue) dosing, which is the most common method of Suboxone delivery. Generic buprenorphine/naloxone is also available as a tablet or pill.
Subutex and Suboxone Side Effects
Subutex and Suboxone, both buprenorphine-containing medications, are generally well tolerated, with few significant adverse effects. The following are the most common and less significant adverse effects of buprenorphine:
Constipation, headaches, nausea, and vomiting are some of the symptoms you may experience.
Drowsiness and exhaustion
Mouth is parched
Muscle spasms and discomfort
Dilated pupils or blurred vision
Disturbance in the focus of attention
Buprenorphine's less common but more dangerous adverse effects include:
Distress in the lungs
Insufficiency of the adrenal glands
Itching, discomfort, swelling, and nerve damage are all symptoms of nerve injury (implant)
Injection site discomfort (injection)
Neonatal abstinence syndrome (NAS) is a condition in which a baby is born (in newborns)
Naloxone will cause severe withdrawal symptoms if Suboxone is injected or snorted. Naloxone, on the other hand, is not orally active when administered sublingually as advised, so withdrawal symptoms do not arise.
Neonatal Abstinence Syndrome (NAS)
Neonatal Abstinence Syndrome (NAS), a drug withdrawal syndrome characterized by disruptions in the gastrointestinal, autonomic, and central nervous systems, is one of the side effects that has received a lot of attention because of its potential to harm the baby.
Symptoms of NAS appear 72 hours after delivery and include the following:
sobbing at a high volume
Sweating has increased.
Reflexes that are overactive
Sucking and feeding problems
NAS can be triggered by any of the prescribed OUD treatments, including methadone and buprenorphine, as well as other substances like nicotine, selective serotonin reuptake inhibitors, and benzodiazepines. In reality, NAS affects 30–80 percent of babies delivered to mothers who use opioid agonists. The risks of relapse and/or untreated addiction to the patient and infant, on the other hand, considerably outweigh the risks of NAS.NAS is a common and manageable illness that is usually managed in a hospital setting with supportive care and morphine.
Recent research contradicts previous fears that Suboxone, with its naloxone component, would increase the likelihood of NAS when compared to Subutex or methadone. To validate or refine these findings, larger prospective clinical trials will be required.
Concerns concerning long-term negative consequences of NAS have been addressed, although observational studies to date have found no indication of serious physiological or developmental issues.
Which Is Better for Pregnant Women: Subutex or Suboxone?
When weighing the benefits and drawbacks of using Subutex or Suboxone to treat pregnant women, it's critical to first consider each medication's safety profile. All buprenorphine drugs, including Subutex and Suboxone, are classified as Category C pharmaceuticals, which indicates there is a chance of side effects during pregnancy. Because of initial worries that the naloxone component of Suboxone could cross the placenta and expose the fetus to possible deleterious effects, Subutex was the most commonly prescribed OUD treatment during pregnancy until recently. "Pills containing both buprenorphine and naloxone are not indicated for treatment of OUD in pregnant women due to limited evidence at this time," the Centers for Disease Control (CDC) continues to declare. The CDC's reluctance to prescribe Suboxone during pregnancy could be due to the lack of bigger, prospective research to better understand the role Suboxone plays in addressing OUD during pregnancy. Nonetheless, studies investigating the use of buprenorphine/naloxone during pregnancy indicated no detrimental effects, and outcomes were comparable when compared to buprenorphine alone, according to a 2017 ACOG Committee opinion.
More recently, a Canadian retrospective study found that buprenorphine/naloxone could be safely used in pregnancy, with maternal and newborn outcomes comparable to those of pregnancies exposed to other opioids and those not exposed to any opioids.
Changing from Subutex to Suboxone While Pregnant or After
Most doctors advise that if a woman is already on methadone and becomes pregnant, she should not switch to buprenorphine because of the considerable risk of triggered withdrawal.
Patients who began buprenorphine treatment as an inpatient may be given a prescription until they see a registered buprenorphine prescriber. Some medical professionals may advise a pregnant Suboxone user to switch to Subutex. "Transferring a pregnant patient to a different opioid agonist with greater addiction potential might not be required," an increasing number of medical professionals argue. 
Switching from Subutex to Suboxone after delivering birth is not only possible, but generally desired to avoid the risk of diversion and misuse associated with Subutex.
Breastfeeding While on Suboxone or Subutex
Breastfeeding is generally advantageous in women on methadone or buprenorphine medications, according to leading medical organizations such as ACOG, SAMHSA, and the CDC, unless they have contraindications such as HIV infection or are using illicit drugs.
Breastfeeding not only promotes connection between a mother and her child and facilitates skin-to-skin contact, but it also gives the baby immunity.
Furthermore, the American Academy of Pediatrics encourages nursing for women who are taking methadone or buprenorphine, regardless of the maternal dose, because these medicines are minimally transferred into breast milk.