ZUBSOLV SIDE EFFECTS
- Generic Name: buprenorphine and naloxone sublingual tablets
- Brand Name: Zubsolv
- Drug Class: Opioid Antagonists
SIDE EFFECTS
The following serious adverse reactions are described elsewhere in the labeling:
- Addiction, Abuse, and Misuse
- Respiratory and CNS Depression
- Neonatal Opioid Withdrawal Syndrome
- Adrenal Insufficiency
- Opioid Withdrawal
- Hepatitis, Hepatic Events
- Hypersensitivity Reactions
- Orthostatic Hypotension
- Elevation of Cerebrospinal Fluid Pressure
- Elevation of Intracholedochal Pressure
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
ZUBSOLV for use as initial treatment was evaluated in two clinical trials that had identical, blinded, two-day induction phases, comparing ZUBSOLV to generic buprenorphine. On the first day, subjects received an initial dose of ZUBSOLV 1.4 mg/0.36 mg or generic buprenorphine 2 mg, followed by ZUBSOLV 4.2 mg/1.08 mg or generic buprenorphine 6 mg 1.5 hours later. In total, safety data were available for 538 opioid-dependent subjects exposed to ZUBSOLV (buprenorphine/naloxone) sublingual tablets when used for initial treatment.
Table 1: Adverse Reactions in ≥ 5% of Patients During the Induction Phase by System Organ Class and Preferred Term (Safety Population)
| System Organ Class Preferred Term | ZUBSOLV (N=538) |
Generic BUP (N=530) |
Overall (N=1068) |
| N (%) | |||
| Patients with any Adverse Reactions | 139 (26%) | 136 (26%) | 275 (26%) |
| Gastrointestinal Disorders | 64 (12%) | 60 (11%) | 124 (12%) |
| Nausea | 29 (5%) | 36 (7%) | 65 (6%) |
| Vomiting | 25 (5%) | 26 (5%) | 51 (5%) |
| Nervous System Disorders | 48 (9%) | 44 (8%) | 92 (9%) |
| Headache | 36 (7%) | 35 (7%) | 71 (7%) |
| BUP = buprenorphine ZUBSOLV = buprenorphine/naloxone |
|||
The safety of buprenorphine/naloxone for longer-term use (up to 16 weeks of treatment) was evaluated in previous studies in 497 opioid-dependent subjects. The prospective evaluation of buprenorphine/naloxone was supported by clinical trials using buprenorphine tablets without naloxone and other trials using buprenorphine sublingual solutions. In total, safety data were available from 3214 opioid-dependent subjects exposed to buprenorphine at doses in the range used in treatment of opioid addiction. See Table 2.
Table 2: Adverse Events > 5% by Body System and Treatment Group in a 4-week Study
| Body System / Adverse Event (COSTART Terminology) | N (%) | N (%) |
| Buprenorphine/ naloxone 16/4 mg/day N=107 |
Placebo N=107 |
|
| Body as a Whole | ||
| Asthenia | 7 (7%) | 7 (7%) |
| Chills | 8 (8%) | 8 (8%) |
| Headache | 39 (37%) | 24 (22%) |
| Infection | 6 (6%) | 7 (7%) |
| Pain | 24 (22%) | 20 (19%) |
| Pain Abdomen | 12 (11%) | 7 (7%) |
| Pain Back | 4 (4%) | 12 (11%) |
| Withdrawal Syndrome | 27 (25%) | 40 (37%) |
| Cardiovascular System | ||
| Vasodilation | 10 (9%) | 7 (7%) |
| Digestive System | ||
| Constipation | 13 (12%) | 3 (3%) |
| Diarrhea | 4 (4%) | 16 (15%) |
| Nausea | 16 (15%) | 12 (11%) |
| Vomiting | 8 (8%) | 5 (5%) |
| Nervous System | ||
| Insomnia | 15 (14%) | 17 (16%) |
| Respiratory System | ||
| Rhinitis | 5 (5%) | 14 (13%) |
| Skin and Appendages | ||
| Sweating | 15 (14%) | 11 (10%) |
The adverse event profile of buprenorphine was also characterized in the dose-controlled study of buprenorphine solution, over a range of doses in four months of treatment. Table 3 shows adverse events reported by at least 5% of subjects in any dose group in the dose-controlled study.
Table 3: Adverse Events (≥ 5%) by Body System and Treatment Group in a 16-week Study
| Body System /Adverse Event (COSTART Terminology) | Buprenorphine dose* | ||||
| Very Low* (N=184) N (%) |
Low* (N=180) N (%) |
Moderate* (N=186) N (%) |
High* (N=181) N (%) |
Total* (N=731) N (%) |
|
| Body as a Whole | |||||
| Abscess | 9 (5%) | 2 (1%) | 3 (2%) | 2 (1%) | 16 (2%) |
| Asthenia | 26 (14%) | 28 (16%) | 26 (14%) | 24 (13%) | 104 (14%) |
| Chills | 11 (6%) | 12 (7%) | 9 (5%) | 10 (6%) | 42 (6%) |
| Fever | 7 (4%) | 2 (1%) | 2 (1%) | 10 (6%) | 21 (3%) |
| Flu Syndrome. | 4 (2%) | 13 (7%) | 19 (10%) | 8 (4%) | 44 (6%) |
| Headache | 51 (28%) | 62 (34%) | 54 (29%) | 53 (29%) | 220 (30%) |
| Infection | 32 (17%) | 39 (22%) | 38 (20%) | 40 (22%) | 149 (20%) |
| Injury Accidental | 5 (3%) | 10 (6%) | 5 (3%) | 5 (3%) | 25 (3%) |
| Pain | 47 (26%) | 37 (21%) | 49 (26%) | 44 (24%) | 177 (24%) |
| Pain Back | 18 (10%) | 29 (16%) | 28 (15%) | 27 (15%) | 102 (14%) |
| Withdrawal Syndrome | 45 (24%) | 40 (22%) | 41 (22%) | 36 (20%) | 162 (22%) |
| Digestive System | |||||
| Constipation | 10 (5%) | 23 (13%) | 23 (12%) | 26 (14%) | 82 (11%) |
| Diarrhea | 19 (10%) | 8 (4%) | 9 (5%) | 4 (2%) | 40 (5%) |
| Dyspepsia | 6 (3%) | 10 (6%) | 4 (2%) | 4 (2%) | 24 (3%) |
| Nausea | 12 (7%) | 22 (12%) | 23 (12%) | 18 (10%) | 75 (10%) |
| Vomiting | 8 (4%) | 6 (3%) | 10 (5%) | 14 (8%) | 38 (5%) |
| Nervous System | |||||
| Anxiety | 22 (12%) | 24 (13%) | 20 (11%) | 25 (14%) | 91 (12%) |
| Depression | 24 (13%) | 16 (9%) | 25 (13%) | 18 (10%) | 83 (11%) |
| Dizziness | 4 (2%) | 9 (5%) | 7 (4%) | 11 (6%) | 31 (4%) |
| Insomnia | 42 (23%) | 50 (28%) | 43 (23%) | 51 (28%) | 186 (25%) |
| Nervousness | 12 (7%) | 11 (6%) | 10 (5%) | 13 (7%) | 46 (6%) |
| Somnolence | 5 (3%) | 13 (7%) | 9 (5%) | 11 (6%) | 38 (5%) |
| Respiratory System | |||||
| Cough Increase | 5 (3%) | 11 (6%) | 6 (3%) | 4 (2%) | 26 (4%) |
| Pharyngitis | 6 (3%) | 7 (4%) | 6 (3%) | 9 (5%) | 28 (4%) |
| Rhinitis | 27 (15%) | 16 (9%) | 15 (8%) | 21 (12%) | 79 (11%) |
| Skin and Appendages | |||||
| Sweat | 23 (13%) | 21 (12%) | 20 (11%) | 23 (13%) | 87 (12%) |
| Special Senses | |||||
| Runny Eyes | 13 (7%) | 9 (5%) | 6 (3%) | 6 (3%) | 34 (5%) |
| *Sublingual solution. Doses in this table cannot necessarily be delivered in tablet form, but for comparison purposes: “Very low” dose (1 mg solution) would be less than a tablet dose of 2 mg “Low” dose (4 mg solution) approximates a 6 mg tablet dose “Moderate” dose (8 mg solution) approximates a 12 mg tablet dose “High” dose (16 mg solution) approximates a 24 mg tablet dose |
|||||
Post-marketing Experience
The following adverse reactions have been identified during post-approval use of buprenorphine and naloxone sublingual tablets. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate a causal relationship to drug exposure. The most frequently reported post-marketing adverse event not observed in clinical trials was peripheral edema.
Serotonin Syndrome
Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concomitant use of opioids with serotonergic drugs.
Adrenal Insufficiency
Cases of adrenal insufficiency have been reported with opioid use, more often following greater than one month of use.
Anaphylaxis
Anaphylaxis has been reported with ingredients contained in ZUBSOLV.
Androgen Deficiency
Cases of androgen deficiency have occurred with chronic use of opioids.
Local Reactions
Glossodynia, glossitis, oral mucosal erythema, oral hypoesthesia, and stomatitis.
SRC: NLM .