Weaning Off Suboxone (Buprenorphine/Naloxone) Guidelines

Introduction to Tapering

The American Academy of Pediatrics recommends that only stable patients without ongoing stressors and who have been maintained on a stable dose for an extended period should be considered for tapering 2
Patients may require treatment indefinitely, as there is no maximum recommended duration of maintenance treatment 1

A gradual dose reduction of 10-20% of the original dose every 24-48 hours is recommended, though individual patient response is more important than rigid adherence to a schedule, according to the American Academy of Pediatrics 3, 2
The tapering process should begin by reducing the daily dose by 10-20% increments, with close monitoring for withdrawal symptoms at each dose reduction 3, 2
If withdrawal symptoms emerge, the current dose should be held or returned to the previous dose, as recommended by the American Academy of Pediatrics 3, 2

Clonidine or lofexidine can be used for autonomic symptoms such as tachycardia, hypertension, and sweating, as recommended by the medical community 1
Antiemetics such as promethazine or ondansetron can be used for nausea and vomiting, according to the medical community 1
Benzodiazepines can be used for anxiety and muscle cramps, as recommended by the medical community 1
Loperamide can be used for diarrhea, according to the medical community 1

Validated withdrawal assessment tools like the Clinical Opiate Withdrawal Scale (COWS) should be used consistently during the tapering process, as recommended by the American Academy of Pediatrics and the medical community 2, 1
Patients should be monitored for signs of relapse, including drug-seeking behavior, missed appointments, or positive urine drug screens, although this is not directly cited, it is implied by the context
Overdose prevention education and take-home naloxone kits should be provided to patients, regardless of taper success, as recommended by the medical community 1
Hepatitis C and HIV screening should be offered to patients, according to the medical community 1
Reproductive health counseling should be considered for patients, as recommended by the medical community 1

Buprenorphine should never be abruptly discontinued, as this precipitates severe withdrawal, according to the American Academy of Pediatrics 3, 2
Rigid adherence to predetermined taper schedules should be avoided, as patient response should guide the pace, as recommended by the American Academy of Pediatrics 3, 2