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What Are the Major Buprenorphine/Suboxone Drug Interactions?

Buprenorphine/Suboxone interactions are common.[1] Some medications may either potentiate or weaken the effects of your Suboxone if taken at the same time. It is therefore important to know what other medications might interact positively or negatively with your Suboxone. While there are no medications that are absolutely contraindicated with Suboxone, there are certainly some medications that should be used cautiously and only with close medical supervision.

These are some of the drug classes that are known to interact with Suboxone.

Drug Type Mild Interactions Moderate Interactions Severe Interactions
Anticonvulsants/nerve pain relievers X
Antibiotics X
Antidepressants X
Antifungals X
Antihistamines X
Antipsychotic X
Barbiturates X
Benzodiazepines X
Muscle relaxants X
Opioids X

Anticonvulsants/Nerve Pain Relievers

Researchers say some anticonvulsant drugs can kick buprenorphine off receptors and potentially make your Suboxone less effective.[2] Some examples of common seizure medications that can potentially interact with Suboxone include Lamotrigine, Carbamazepine, Phenytoin, or Gabapentin. If you're using Suboxone to resist relapse temptations, anticonvulsants could put your sobriety at risk. If you need to be on a specific anti-seizure or epileptic medication, make sure your doctor knows that you are also on Suboxone and ask about any potential interactions. 

Antidepressants

Depression symptoms are common in early recovery. Your brain cells need time to heal, and while they do, they may be incapable of producing feel-good chemicals. Antidepressants can help, but some medications can reduce buprenorphine metabolism.[3] Many patients are on both antidepressants and Suboxone together safely. It is possible and in fact very common to use both, but make sure your doctor is aware of all medications you are taking while on Suboxone, including antidepressants. 

Antibiotics 

If you have a history of injecting drugs, you may have infected sores on your arms and legs. Antibiotic therapy can help remove active infections, but some types can interfere with the body's processing of Suboxone. Tell your doctor prior to taking any antibiotics to make sure it will not interact with your Suboxone. 

Antifungal Medications

Some people develop fungal infections like ringworm or yeast infections that require antifungal treatment. Fungal infections can also occur commonly with needle use with persons who are injecting drugs. Some antifungals can decrease the efficacy of Suboxone. [3] If you need an antifungal agent, make sure you ask your doctor about any potential interactions with Suboxone. 

Antihistamines

Most over the counter antihistamines, usually prescribed for allergies, are safe to use with Suboxone.[3] However, some versions of these medications, particularly diphenhydramine (benadryl) or hydroxyzine can be sedating and, in combination with Suboxone, can make you overly sedated. Talk to your doctor about choosing antihistamine formulations that are less sedating such as Loratidine (Claritin). 

Antipsychotics

Many antipsychotic medications have sedative qualities, meaning that they can slow breathing rates and cause sedation and drowsiness. Many people who are on Suboxone need these medications for a related mental health condition. Many people can safely take anti-psychotics along with Suboxone, however make sure your doctor is aware that you are using both classes of medications so they can ensure safe dosing. 

Barbiturates

Barbiturate medications are also sedative drugs, and just like antipsychotics, they can slow breathing and heart rates when combined with buprenorphine. If you have a specific reason to need to take a barbiturate along with Suboxone, talk to your doctor before doing so. 

Benzodiazepines

People are more likely to go to the emergency room with buprenorphine-related problems when they also have benzodiazepine prescriptions.[5] And many deaths attributed to buprenorphine are in people who were also taking benzodiazepines.[6] Of all the medications we've discussed so far, benzodiazepines are probably the most commonly misused in combination with Suboxone. Never mix benzodiazepines and Suboxone without first talking with your doctor. 

Muscle Relaxants

Aching, twitching muscles are common in early recovery. Muscle relaxants can help, but they also can cause sleepiness and sedation. Mixing Suboxone and muscle relaxants can lead to significant respiratory depression. If you do have a reason that you need to take a muscle relaxer while on Suboxone, discuss with your doctor prior to doing so.  

How to Avoid Drug Interactions

Talk with your doctor about all the drugs you take before you start therapy with Suboxone. Bring your pills with you, if possible, so your doctor understands your doses. Go to the same pharmacy to fill all your prescriptions, if possible. Your pharmacist can also check for interactions to keep you safe. And remember: Never take Suboxone without a prescription.

References

  1. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed June 2022. 
  1. Effect of Five Common Anticonvulsant Drugs on Naloxone-Precipitated Morphine Withdrawal in Mice. Research in Pharmaceutical Sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203273/. January 2011. Accessed June 2022. 
  1. Drug Interactions of Clinical Importance Among the Opioids, Methadone and Buprenorphine, and Other Frequently Prescribed Medications: A Review. American Journal of Addiction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334287/. April 2012. Accessed June 2022. 
  1. Azole Antifungal Inhibition of Buprenorphine, Methadone, and Oxycodone In Vitro Metabolization. Journal of Analytical Toxicology. https://academic.oup.com/jat/article/39/5/374/760692. June 2015. Accessed June 2022. 
  1. Benzodiazepine Use During Buprenorphine Treatment for Opioid Dependence: Clinical and Safety Outcomes. Drug and Alcohol Dependence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916951/. October 2014. Accessed June 2022. 
  1. Associations Between Prescribed Benzodiazepines, Overdose Death, and Buprenorphine Discontinuation Among People Receiving Buprenorphine. Addiction. https://pubmed.ncbi.nlm.nih.gov/31916306/. January 2020. Accessed June 2022.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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