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Buprenorphine

Also known as: Buprenorphine

Partial Opioid AgonistPartial Opioid Agonists

Route: Sublingual

33 interactions on record⛔ Black Box Warning

Buprenorphine has 33 known drug interactions based on U.S. FDA drug labeling data. 22 are classified as major interactions requiring close medical supervision. Notable interactions include combinations with Alcohol, Alprazolam, Alprazolam C-Iv. Patients taking Buprenorphine should inform their healthcare provider of all current medications — including over-the-counter drugs and supplements — to avoid potentially harmful combinations. Data sourced from OpenFDA and the NIH National Library of Medicine.

Total: 33
Major: 22
Moderate: 8

Major (22)

Buprenorphine + Alcohol— CNS depressant effects increase risk of respiratory depression, profound sedation, coma, and death.
Buprenorphine + Alprazolam— Concomitant use increases risk of respiratory depression due to actions at different CNS receptor sites.
Buprenorphine + Alprazolam C-Iv— Concomitant use increases risk of respiratory depression due to additive CNS effects at different receptor sites. Monito…
Buprenorphine + Atropa Belladonna And Opium— Partial agonist opioid may reduce analgesic effect and/or precipitate withdrawal symptoms. Avoid concomitant use.
Buprenorphine + Erythromycin— CYP3A4 inhibitor that increases buprenorphine plasma concentration, resulting in increased or prolonged opioid effects a…
Buprenorphine + Gabapentin— Gabapentinoid CNS depressant increases risk of respiratory depression, profound sedation, coma, and death.
Buprenorphine + Hydrocodone Bitartrate And Acetaminophen— Partial agonist may precipitate withdrawal in opioid-dependent patients.
Buprenorphine + Hydromorphone Hydrochloride— May reduce analgesic effect of hydromorphone and/or precipitate withdrawal symptoms. Avoid concomitant use.
Buprenorphine + Itraconazole— Itraconazole increases buprenorphine (IV and sublingual) concentrations. Monitor for adverse reactions; concomitant drug…
Buprenorphine + Ketoconazole— CYP3A4 inhibitor that increases buprenorphine plasma concentration, resulting in increased or prolonged opioid effects a…
Buprenorphine + Morphine Sulfate— Partial agonist opioid may reduce analgesic effect and/or precipitate withdrawal symptoms. Avoid concomitant use.
Buprenorphine + Muscle Relaxants— CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant bupren…
Buprenorphine + Naloxone Hydrochloride— Large doses of naloxone required to antagonize buprenorphine due to its long duration of action and slow dissociation fr…
Buprenorphine + Nitrazepam— Additive CNS depressant effects increase risk of respiratory depression, profound sedation, coma, and death.
Buprenorphine + Other Anticholinergic Agents— Concomitant use increases risk of respiratory depression, profound sedation, coma, and death due to additive opioid effe…
Buprenorphine + Pentazocine Hydrochloride And Naloxone Hydrochloride— Partial agonist opioid may reduce analgesic effect and precipitate withdrawal symptoms. Avoid concomitant use.
Buprenorphine + Pregabalin— Gabapentinoid CNS depressant increases risk of respiratory depression, profound sedation, coma, and death.
Buprenorphine + Ritonavir— CYP3A4 inhibitor that increases buprenorphine plasma concentration, resulting in increased or prolonged opioid effects a…
Buprenorphine + Sedating Antihistamines— Concomitant use increases risk of respiratory depression, profound sedation, coma, and death due to additive CNS depress…
Buprenorphine + Sedatives— CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant bupren…
Buprenorphine + Topical Local Anesthetics— CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant bupren…
Buprenorphine + Tranquilizers— CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant bupren…

Moderate (8)

Buprenorphine + Acetaminophen, Caffeine, Dihydrocodeine Bitartrate— Mixed agonist/antagonist opioid may reduce the analgesic effect of this combination product.
Buprenorphine + Atazanavir— Other PIs with CYP3A4 inhibitory activity (atazanavir and atazanavir/ritonavir) resulted in elevated levels of buprenorp…
Buprenorphine + Indinavir— CYP3A4 inhibitor (HIV protease inhibitor) can increase plasma concentration of buprenorphine. Monitoring recommended whe…
Buprenorphine + Mao Inhibitors— Can increase plasma concentration of buprenorphine, resulting in increased or prolonged opioid effects; discontinuation …
Buprenorphine + Oxycodone Hydrochloride— Mixed agonist/antagonist may reduce analgesic effect and/or precipitate withdrawal symptoms in opioid-dependent patients…
Buprenorphine + Remifentanil Hydrochloride— Partial agonist opioid may reduce analgesic effect of remifentanil and/or precipitate withdrawal symptoms.
Buprenorphine + Saquinavir— CYP3A4 inhibitor (HIV protease inhibitor) can increase plasma concentration of buprenorphine. Monitoring recommended whe…
Buprenorphine + Tapentadol Hydrochloride— Mixed agonist/antagonist and partial agonist opioids may reduce analgesic effect of tapentadol and/or precipitate withdr…

Buprenorphine + Alcohol⚠️Major

CNS depressant effects increase risk of respiratory depression, profound sedation, coma, and death.

Buprenorphine + Alprazolam⚠️Major

Concomitant use increases risk of respiratory depression due to actions at different CNS receptor sites.

Buprenorphine + Alprazolam C-Iv⚠️Major

Concomitant use increases risk of respiratory depression due to additive CNS effects at different receptor sites. Monitor closely for respiratory depression and sedation.

Buprenorphine + Atropa Belladonna And Opium⚠️Major

Partial agonist opioid may reduce analgesic effect and/or precipitate withdrawal symptoms. Avoid concomitant use.

Buprenorphine + Erythromycin⚠️Major

CYP3A4 inhibitor that increases buprenorphine plasma concentration, resulting in increased or prolonged opioid effects and respiratory depression risk.

Buprenorphine + Gabapentin⚠️Major

Gabapentinoid CNS depressant increases risk of respiratory depression, profound sedation, coma, and death.

Buprenorphine + Hydrocodone Bitartrate And Acetaminophen⚠️Major

Partial agonist may precipitate withdrawal in opioid-dependent patients.

Buprenorphine + Hydromorphone Hydrochloride⚠️Major

May reduce analgesic effect of hydromorphone and/or precipitate withdrawal symptoms. Avoid concomitant use.

Buprenorphine + Itraconazole⚠️Major

Itraconazole increases buprenorphine (IV and sublingual) concentrations. Monitor for adverse reactions; concomitant drug dose reduction may be necessary.

Buprenorphine + Ketoconazole⚠️Major

CYP3A4 inhibitor that increases buprenorphine plasma concentration, resulting in increased or prolonged opioid effects and respiratory depression risk.

Buprenorphine + Morphine Sulfate⚠️Major

Partial agonist opioid may reduce analgesic effect and/or precipitate withdrawal symptoms. Avoid concomitant use.

Buprenorphine + Muscle Relaxants⚠️Major

CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant buprenorphine use.

Buprenorphine + Naloxone Hydrochloride⚠️Major

Large doses of naloxone required to antagonize buprenorphine due to its long duration of action and slow dissociation from opioid receptor. Antagonism characterized by gradual onset and decreased duration of effect.

Buprenorphine + Nitrazepam⚠️Major

Additive CNS depressant effects increase risk of respiratory depression, profound sedation, coma, and death.

Buprenorphine + Other Anticholinergic Agents⚠️Major

Concomitant use increases risk of respiratory depression, profound sedation, coma, and death due to additive opioid effects.

Buprenorphine + Pentazocine Hydrochloride And Naloxone Hydrochloride⚠️Major

Partial agonist opioid may reduce analgesic effect and precipitate withdrawal symptoms. Avoid concomitant use.

Buprenorphine + Pregabalin⚠️Major

Gabapentinoid CNS depressant increases risk of respiratory depression, profound sedation, coma, and death.

Buprenorphine + Ritonavir⚠️Major

CYP3A4 inhibitor that increases buprenorphine plasma concentration, resulting in increased or prolonged opioid effects and respiratory depression risk.

Buprenorphine + Sedating Antihistamines⚠️Major

Concomitant use increases risk of respiratory depression, profound sedation, coma, and death due to additive CNS depressant effects.

Buprenorphine + Sedatives⚠️Major

CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant buprenorphine use.

Buprenorphine + Topical Local Anesthetics⚠️Major

CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant buprenorphine use.

Buprenorphine + Tranquilizers⚠️Major

CNS depressants that increase risk of respiratory depression, profound sedation, coma, and death with concomitant buprenorphine use.

Buprenorphine + Acetaminophen, Caffeine, Dihydrocodeine Bitartrate🟡Moderate

Mixed agonist/antagonist opioid may reduce the analgesic effect of this combination product.

Buprenorphine + Atazanavir🟡Moderate

Other PIs with CYP3A4 inhibitory activity (atazanavir and atazanavir/ritonavir) resulted in elevated levels of buprenorphine and norbuprenorphine, and patients in one study reported increased sedation. Symptoms of opioid excess have been found in postmarketing reports of patients receiving buprenorphine and atazanavir with and without ritonavir concomitantly. Intervention: Monitor patients taking buprenorphine sublingual tablets and atazanavir with and without ritonavir, and reduce dose of buprenorphine sublingual tablets if warranted.

Buprenorphine + Indinavir🟡Moderate

CYP3A4 inhibitor (HIV protease inhibitor) can increase plasma concentration of buprenorphine. Monitoring recommended when transferring to or initiating with SUBLOCADE.

Buprenorphine + Mao Inhibitors🟡Moderate

Can increase plasma concentration of buprenorphine, resulting in increased or prolonged opioid effects; discontinuation may result in decreased efficacy or withdrawal.

Buprenorphine + Oxycodone Hydrochloride🟡Moderate

Mixed agonist/antagonist may reduce analgesic effect and/or precipitate withdrawal symptoms in opioid-dependent patients.

Buprenorphine + Remifentanil Hydrochloride🟡Moderate

Partial agonist opioid may reduce analgesic effect of remifentanil and/or precipitate withdrawal symptoms.

Buprenorphine + Saquinavir🟡Moderate

CYP3A4 inhibitor (HIV protease inhibitor) can increase plasma concentration of buprenorphine. Monitoring recommended when transferring to or initiating with SUBLOCADE.

Buprenorphine + Tapentadol Hydrochloride🟡Moderate

Mixed agonist/antagonist and partial agonist opioids may reduce analgesic effect of tapentadol and/or precipitate withdrawal symptoms. Concomitant use should be avoided.

Buprenorphine + Lopinavirℹ️Unknown

Examples: efavirenz, nevirapine, etravirine, delavirdine Antiretrovirals: Protease inhibitors (PIs) Clinical Impact: Studies have shown some antiretroviral protease inhibitors (PIs) with CYP3A4 inhibitory activity (nelfinavir, lopinavir/ritonavir, ritonavir) have little effect on buprenorphine pharmacokinetic and no significant pharmacodynamic effects.

Buprenorphine + Metaxaloneℹ️Unknown

Examples: cyclobenzaprine, metaxolone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.

Buprenorphine + Nelfinavirℹ️Unknown

Data sourced from U.S. FDA drug labeling via openFDA and the NIH National Library of Medicine. For informational purposes only. Always consult your pharmacist or physician.