Bunavail: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Jan 3, 2024.

1. How it works

• Bunavail is a combination buccal film containing buprenorphine and naloxone.
• Buprenorphine is an opioid (narcotic) that has a unique and complex mechanism of action, which includes incomplete binding to mu opioid receptors and complete binding to kappa opioid receptors. Opioid receptors have three main effects: reducing breathing (respiratory depression), producing euphoria (feelings of intense happiness or excitement), and decreasing pain. The way buprenorphine binds means it can satisfy opioid cravings without producing strong feelings of euphoria or causing significant respiratory depression. In addition, while it is bound to opioid receptors, other opioids (such as heroin or oxycodone) cannot bind. It also stays on the receptors for longer - about three days; which makes it a good choice for use in opioid addiction treatment programs.
• Naloxone is present in this combination tablet to discourage misuse. Naloxone is a very strong blocker of mu opioid receptors and will precipitate people into opioid withdrawal if drug misusers attempt to convert the film into an injectable form. Naloxone has poor absorption when taken sublingually (under the tongue).
• Bunavail belongs to the class of medicines known as combination opioid/opioid antagonists.
• The Bunavail brand name has been discontinued in the United States.

2. Upsides

• May be used in the treatment of opiate dependence (under strict conditions), usually after an initial induction with buprenorphine sublingual tablets.
• Can be given as a single daily dose.
• Dosage can be progressively adjusted until the correct dosage is found that holds the patient in treatment and suppresses opioid withdrawal symptoms.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Constipation, diarrhea, difficulty sleeping, flushing or redness of the skin, headache, nausea or vomiting, pain, or sweating.
• Oral numbness has also been reported with the buccal film.
• Has the potential to cause serious, life-threatening breathing problems. This is more likely in people who misuse Bunavail, or when used in combination with other medications that also affect breathing. The elderly or debilitated, and those with pre-existing breathing problems are also at higher risk.
• May be habit-forming, even at the dosage prescribed by your doctor.
• May cause sleepiness or dizziness and affect a person's ability to drive or operate machinery. Alcohol should be avoided.
• Abnormal liver function tests have also been reported; ongoing tests that monitor liver function may be needed.
• May cause a severe lowering of blood pressure, or a sudden drop in blood pressure when going from sitting to standing.
• Risk of heart rhythm disorders (such as QT prolongation), particularly at higher dosages.
• Bunavail is not interchangeable with other brands of buprenorphine/naloxone combination tablets (for example, Suboxone sublingual tablets require a different dose than Bunavail buccal film). Monitor for signs of over-medication as well as withdrawal or under-dosing when switching brands.
• Misuse of Bunavail can cause addiction, overdose, or death.
• There is no generic version of Bunavail available. Other buprenorphine/naloxone films are available as a generic, but these are different strengths than Bunavail and are taken in a slightly different way, for example, under the tongue or between your gum and cheek. Suboxone films and Zubsolv tablets also contain buprenorphine and naloxone but these are also not the same as Bunavail.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Bunavail is a combination buprenorphine/naloxone oral film that helps suppress opioid withdrawal symptoms and is used for the maintenance treatment of opioid drug dependence. The Bunavail brand has been discontinued in the United States but other preparations containing buprenorphine and naloxone are available, but these are not the same.

5. Tips

• Never share Bunavail with another person, particularly those with a history of drug abuse or addiction.
• When using Bunavail buccal film, rinse the mouth with water or wet the inside of the cheek before placing the film inside the mouth. Hold the film in place for 5 seconds; the film should stay in place after this. Avoid manipulating the film with your tongue or fingers or eating or drinking until the film has dissolved. Never cut or tear the film.
• Bunavail is not interchangeable with other brands of buprenorphine/naloxone sublingual or buccal tablets. When switching between brands, dosage adjustments, and monitoring may be necessary. Talk with your doctor.
• Bunavail can cause sedation and affect your ability to drive or operate machinery.
• Do not drink alcohol while you are taking Bunavail.
• Talk to your doctor or pharmacist before taking any other medications or natural products with Bunavail because it may not be compatible with some products.
• Keep out of reach of children and pets because even one dose can be fatal.
• Tell other health providers including dentists that you are being treated with Bunavail.

6. Response and effectiveness

• The time it takes to absorb Bunavail varies significantly from person to person; however, in most people, the peak effect is reached within 100 minutes.
• Buprenorphine has a ceiling effect, which means that once a certain dose is reached, further doses produce no further effect.
• Coadministration with liquids reduced the absorption of buprenorphine by 59% and naloxone, by up to 76%, which is why the film should be allowed to dissolve in the mouth without water or food.

7. Interactions

Medicines that interact with Bunavail may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Bunavail. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Bunavail include:

• 5-hydroxytryptophan
• albuterol
• antibiotics, such as azithromycin, clarithromycin, erythromycin, and norfloxacin
• antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
• antifungal agents, such as itraconazole and ketoconazole
• anticonvulsants, such as brivaracetam, carbamazepine, divalproex, lamotrigine, phenytoin, phenobarbital, or primidone
• antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, aripiprazole, olanzapine, quetiapine, ziprasidone)
• any medication that may cause drowsiness, such as benzodiazepines (eg, alprazolam, diazepam, lorazepam), sleeping pills (such as zolpidem or ziprasidone), or first-generation antihistamines (such as doxylamine or promethazine)
• bisacodyl
• bupropion
• buspirone
• busulfan
• cannabis
• cyclosporine
• dapsone
• dasatinib
• droperidol
• echinacea
• flucloxacillin
• heart medications such as amlodipine, atenolol, or candesartan
• HIV medications, such as delavirdine or ritonavir
• metoclopramide
• muscle relaxants, such as baclofen or cyclobenzaprine
• opioids such as codeine, fentanyl, or morphine
• pregabalin
• rifampin
• sodium oxybate
• valerian
• other medications that affect serotonin, such as amphetamines, lithium, tramadol, or triptans (eg, almotriptan, eletriptan, or sumatriptan).

Avoid grapefruit products and drinking alcohol or taking illegal or recreational drugs while taking Bunavail.

Note that this list is not all-inclusive and includes only common medications that may interact with Bunavail. You should refer to the prescribing information for Bunavail for a complete list of interactions.

References

• Bunavail. Updated 03/2023. BioDelivery Sciences International, Inc. https://www.drugs.com/pro/bunavail-buccal-film.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Bunavail only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2024 Drugs.com. Revision date: January 2, 2024.

Medical Disclaimer