It’s common to have questions about the safety of over-the-counter (OTC) medications and supplements taken with buprenorphine (Suboxone, Subutex).  Your Bicycle Health provider will answer all questions you may have about medication interactions, and your pharmacist is also a valuable resource for questions specific to you.  That said, buprenorphine has relatively few interactions with common OTC medications, and the following general guidance may help inform your choices.  This guidance does not consider pregnancy; if you are pregnant, always talk to your obstetrician before taking any medication or supplement including OTCs.

1. Pain Medications:  If you have used an OTC pain medication (acetaminophen, ibuprofen, naproxen, or aspirin) before starting buprenorphine and have not been advised by a medical professional to avoid it, it is safe to continue after starting buprenorphine. Never take both ibuprofen and naproxen together because they are in the same medication class, and taking them together is the same as taking an excessive dose of either.  Aspirin slows blood-clotting and is not preferred for pain when compared to the other 3 OTC options, but if advised by a medical professional to take aspirin for heart-related or other reasons, it is safe to continue on buprenorphine.
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2. Sleep Aids: Many OTC sleep aids contain diphenhydramine (Benadryl) or doxylamine.  Do not take diphenhydramine or doxylamine with hydroxyzine (Vistaril), which is commonly prescribed for withdrawal when first starting buprenorphine.  Melatonin and chamomile are safe with buprenorphine and hydroxyzine.  Less commonly, tryptophan is present in some sleep aids and is also safe with buprenorphine and hydroxyzine.
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3. Anti-diarrhea: If you have used loperamide (Imodium) or bismuth subsalicylate (Pepto) before and have not been advised by a medical professional to avoid it, either medication is safe to use just before and after starting buprenorphine while experiencing withdrawal.  Since buprenorphine itself is also constipating, these anti-diarrhea medications should only be used when needed for short periods of time while on buprenorphine unless directed otherwise by your physician.
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4. Anti-nausea and indigestion: ginger supplements can be helpful for nausea and are safe to take with buprenorphine.  Also if you have used bismuth subsalicylate (Pepto-Bismol) before and have not been advised by a medical professional to avoid it, it’s safe to take with buprenorphine.  For indigestion, calcium carbonate (TUMS) are safe.
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5. Laxatives: Docusate (Colace) stool softener, psyllium fiber (Metamucil), and glycerin suppository (Fleet) are safe with buprenorphine.  Polyethylene glycol (Miralax) is also ok, and both bisacodyl (Dulcolax) and sennosides (Ex-lax) are stimulant laxatives that are safe as well.  If you’ve been advised by a medical professional to use magnesium citrate as a laxative, that is also safe with buprenorphine but is generally not preferred for routine use compared to other OTC options.
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6. Allergy medications: loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) are ok to take with buprenorphine.  Nasal fluticasone (Flonase) and nasal triamcinolone (Nasocort) are also ok with buprenorphine.  Diphenhydramine (Benadryl) should not be taken with hydroxyzine (Vistaril) which is commonly prescribed for withdrawal when starting buprenorphine.
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7. Cough and Cold: Do not take dextromethorphan (Robitussin) with buprenorphine.  Guaifenacin is ok.  Many cold preparations contain multiple ingredients that may also be pain relievers and sleep aids.  Be sure to review each active ingredient to ensure you’re not doubling-up, and consult your pharmacist if ever unsure of what’s in an OTC medication.
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8. Sinus Congestion: nasal saline (Netti Pot) and vaporizers (Vick’s) are safe to use with buprenorphine.  Pseudoephedrine (Sudafed), phenylephrine, and caffeine are all stimulants commonly found in sinus preparations that can make withdrawal-related anxiety and shakiness worse, and will interfere with sleep.  That said, if you have used them before starting buprenorphine and have not been advised by a medical professional to avoid them, each is ok to take with buprenorphine. 
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9. Daily Vitamins: Women’s, Men’s, and non-gendered daily multi-vitamins are safe with buprenorphine.  B-vitamins, vitamin C, and folic acid are also safe.  If you’ve been advised by a medical professional to take OTC calcium, vitamin D, iron, magnesium, thiamine, CoQ10, or fish oil, these are also safe to take with buprenorphine.
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10. Supplements: Protein, fiber, and probiotic supplements are safe with buprenorphine.  Other types of supplements, especially those advertised as enhancing weight loss, muscle mass, or metabolic rate, are far too varied to discuss here and may have stimulant, hormonal, or metabolic effects that may cause adverse reactions with buprenorphine.  Supplements that are advertised to help opioid dependence or opioid addiction should never be taken with or even before starting buprenorphine; these supplements often have opioid and addictive properties themselves and can cause a severe withdrawal reaction if taken with or before buprenorphine.  All in all, if it’s a supplement that is not simply protein, fiber, a probiotic, or a vitamin or food discussed above, consult your Bicycle Health provider before taking it with buprenorphine.

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