Initial dose is usually 2-4mg buprenorphine/naloxone on the first day with subsequent doses titrated upwards against withdrawal symptoms in 2-4mg increments, to a maximum daily dose of 32mg. For most patients, good compliance can be achieved in the range 8-16mg daily. Unlike methadone there are no buprenorphine/naloxone 'fast metabolizers' and once-daily dosing is appropriate for the vast majority of patients.
For some patients who have had a suitable period of stabilisation at a regular daily dose, the frequency of dosing may be reduced to alternate-days at twice the titrated daily dose, with no reduction in clinical effect. For example, a patient stable at 8mg buprenorphine/naloxone daily may be prescribed 16mg on alternate days. However, the maximum dose given on any one day should never exceed 32mg and alternate-day dosing should only be done with the full informed consent of the patient.
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