Dosing & Uses
Dosage Forms & Strengths
buccal film: Schedule III
- 75mcg
- 150mcg
- 300mcg
- 450mcg
- 600mcg
- 750mcg
- 900mcg
Chronic Severe Pain
Indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate
Buccal film for oral buccal use only; apply to buccal mucosa q12hr
Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse
Opioid-naïve
- Initiate with 75 mcg film qDay or, if tolerated, q12hr for at least 4 days, then increase dose to 150 mcg q12hr
- Individual titration to a dose that provides adequate analgesia and minimizes adverse reactions should proceed in increments of 150 mcg q12hr, no more frequently than every 4 days
- Doses up to 450 mcg q12hr were studied in opioid-naïve patients in the clinical trials
Conversion from other opioids
- There is a potential for buprenorphine to precipitate withdrawal in patients who are already on opioids
- To reduce the risk of opioid withdrawal, taper patients ≤30 mg oral morphine sulfate equivalents (MSE) daily before beginning buprenorphine buccal
- May supplement with prompt-acting opioid and nonopioid analgesic for break-through pain during taper
-
Following analgesic taper, base the starting dose on the patient’s daily opioid dose prior to taper, as described
- Oral morphine equivalent <30 mg/day: Initiate with 75 mcg qDay or q12hr
- Oral morphine equivalent 30-89 mg/day: Initiate with 150 mcg q12hr
- Oral morphine equivalent 90-160 mg/day: Initiate with 300 mcg q12hr
- Oral morphine equivalent >160 mg/day: Consider alternate analgesic
- Buprenorphine buccal doses of 600 mcg, 750 mcg, and 900 mcg are only for use following titration from lower doses of buprenorphine buccal
- Individual titration should proceed in increments of 150 mcg q12h, no more frequently than every 4 days
Conversion from methadone
- Close monitoring is of particular importance when converting from methadone to other opioid agonists, including buprenorphine buccal
- The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure
- Methadone has a long half-life and can accumulate in the plasma
Titration and maintenance dose
- Individually titrate to a dose that provides adequate analgesia and minimizes adverse reactions
- Continually reevaluate to assess the maintenance of pain control and the relative incidence of adverse reactions and monitor for the development of addiction, abuse, or misuse
- Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration
- During long-term therapy, periodically reassess the continued need for opioid analgesics
- The minimum titration interval is 4 days, based on the pharmacokinetic profile and time to reach steady-state plasma levels
- Individual titration should proceed in increments that do not exceed 150 mcg q12hr
- Maximum dose: 900 mcg q12hr; do not exceed this dose because of potential for QTc interval prolongation
- If pain is not adequately managed on buprenorphine buccal 900 mcg, consider an alternate analgesic
- Patients who experience breakthrough pain may require dosage adjustment of buprenorphine or may need rescue medication with an appropriate dose of an immediate-release analgesic
- If the level of pain increases after dose stabilization, attempt to identify the source of increased pain before increasing the dose
- If unacceptable opioid-related adverse reactions are observed, adjust the dose to obtain an appropriate balance between the management of pain and opioid-related adverse reactions
Dosage Modifications
Renal impairment: No dosage adjustment required for any level of renal impairment
Oral mucositis: In patients with known or suspected mucositis, reduce the starting dosage and titration incremental dosage by half compared with patients without mucositis
Hepatic impairment
- Mild (Child-Pugh A): No dosage adjustment required
- Moderate (Child-Pugh B): No dosage adjustment required; however, monitor these patients for signs and symptoms of toxicity or overdose
- Severe (Child-Pugh C): Reduce the starting dose and reduce the titration dose by half that of patients with normal liver function, from 150 mcg to 75 mcg
Dosing Considerations
Access to naloxone for opioid overdose
- Assess need for naloxone upon initiating and renewing treatment
-
Consider prescribing naloxone
- Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management
- Household members (including children) or other close contacts at risk for accidental ingestion or overdose
-
Consult patients and caregivers on the following:
- Availability of naloxone for emergency treatment of opioid overdose
- Ways to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program)
Limitations of use
- Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients in whom alternative treatment options (eg, nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain
- Not indicated as a PRN analgesic
Safety and efficacy not established
Although specific dose adjustments on the basis of advanced age are not required for pharmacokinetic reasons, use caution in the elderly population to ensure safe use
Clinical trials observed that some adverse effects (ie, respiratory depression, constipation, urinary retention) occur more frequently in elderly patients
See adult dosing
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (5)
- alvimopan
alvimopan, buprenorphine buccal. receptor binding competition. Contraindicated. Contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea.
- dronedarone
buprenorphine buccal and dronedarone both increase QTc interval. Contraindicated.
- fezolinetant
buprenorphine buccal will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors
- posaconazole
buprenorphine buccal and posaconazole both increase QTc interval. Contraindicated.
- thioridazine
buprenorphine buccal and thioridazine both increase QTc interval. Contraindicated.
Serious - Use Alternative (201)
- acrivastine
acrivastine and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- alfentanil
buprenorphine buccal, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- amiodarone
buprenorphine buccal and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
buprenorphine buccal and amisulpride both increase QTc interval. Avoid or Use Alternate Drug.
amisulpride and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - amitriptyline
buprenorphine buccal and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- amoxapine
buprenorphine buccal and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.
- anagrelide
buprenorphine buccal and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- apomorphine
buprenorphine buccal and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
buprenorphine buccal and aripiprazole both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
buprenorphine buccal and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
buprenorphine buccal and artemether both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
buprenorphine buccal and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
buprenorphine buccal and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
asenapine and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - asenapine transdermal
asenapine transdermal and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- atomoxetine
buprenorphine buccal and atomoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- avapritinib
avapritinib and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- azithromycin
buprenorphine buccal and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
buprenorphine buccal and bedaquiline both increase QTc interval. Avoid or Use Alternate Drug.
- belladonna and opium
buprenorphine buccal, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- benzhydrocodone/acetaminophen
buprenorphine buccal decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients.
benzhydrocodone/acetaminophen and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - brexpiprazole
brexpiprazole and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- brimonidine
brimonidine and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- brivaracetam
brivaracetam and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine subdermal implant
buprenorphine subdermal implant and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- butorphanol
buprenorphine buccal, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- calcium/magnesium/potassium/sodium oxybates
buprenorphine buccal, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- ceritinib
buprenorphine buccal and ceritinib both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
buprenorphine buccal and chloroquine both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
buprenorphine buccal and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- cimetidine
cimetidine increases effects of buprenorphine buccal by decreasing metabolism. Avoid or Use Alternate Drug.
- ciprofloxacin
buprenorphine buccal and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
buprenorphine buccal and citalopram both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
buprenorphine buccal and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
buprenorphine buccal and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
- clonidine
clonidine, buprenorphine buccal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.
- clozapine
buprenorphine buccal and clozapine both increase QTc interval. Avoid or Use Alternate Drug.
- codeine
buprenorphine buccal, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- crizotinib
buprenorphine buccal and crizotinib both increase QTc interval. Avoid or Use Alternate Drug.
- dasatinib
buprenorphine buccal and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
buprenorphine buccal and degarelix both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
buprenorphine buccal and desflurane both increase QTc interval. Avoid or Use Alternate Drug.
- desipramine
buprenorphine buccal and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
- deutetrabenazine
buprenorphine buccal and deutetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- dextromoramide
buprenorphine buccal, dextromoramide. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diamorphine
buprenorphine buccal, diamorphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diazepam intranasal
diazepam intranasal, buprenorphine buccal. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- difenoxin hcl
buprenorphine buccal, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diphenoxylate hcl
buprenorphine buccal, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- dipipanone
buprenorphine buccal, dipipanone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- disopyramide
buprenorphine buccal and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
buprenorphine buccal and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
buprenorphine buccal and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
buprenorphine buccal and donepezil both increase QTc interval. Avoid or Use Alternate Drug.
- doxepin
buprenorphine buccal and doxepin both increase QTc interval. Avoid or Use Alternate Drug.
- efavirenz
buprenorphine buccal and efavirenz both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
buprenorphine buccal and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.
- eluxadoline
buprenorphine buccal, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .
- encorafenib
buprenorphine buccal and encorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
buprenorphine buccal and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
buprenorphine buccal and eribulin both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
buprenorphine buccal and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
buprenorphine buccal and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
buprenorphine buccal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
buprenorphine buccal and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
buprenorphine buccal and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.
- fentanyl
buprenorphine buccal decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.
fentanyl, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation. - fentanyl intranasal
buprenorphine buccal decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.
fentanyl intranasal, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation. - fentanyl transdermal
buprenorphine buccal decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.
fentanyl transdermal, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation. - fentanyl transmucosal
buprenorphine buccal decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.
fentanyl transmucosal, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation. - fexinidazole
buprenorphine buccal and fexinidazole both increase QTc interval. Avoid or Use Alternate Drug.
- fingolimod
buprenorphine buccal and fingolimod both increase QTc interval. Avoid or Use Alternate Drug.
- flecainide
buprenorphine buccal and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluconazole
buprenorphine buccal and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
buprenorphine buccal and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
buprenorphine buccal and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
buprenorphine buccal and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- fostemsavir
buprenorphine buccal and fostemsavir both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
buprenorphine buccal and gemifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- gemtuzumab
buprenorphine buccal and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
buprenorphine buccal and gilteritinib both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
buprenorphine buccal and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.
- goserelin
buprenorphine buccal and goserelin both increase QTc interval. Avoid or Use Alternate Drug.
- granisetron
buprenorphine buccal and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- haloperidol
buprenorphine buccal and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- histrelin
buprenorphine buccal and histrelin both increase QTc interval. Avoid or Use Alternate Drug.
- hydrocodone
buprenorphine buccal decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients. .
- hydromorphone
buprenorphine buccal, hydromorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- hydroxychloroquine sulfate
buprenorphine buccal and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
buprenorphine buccal and hydroxyzine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration necessary, consider consider dose reduction of one or both drugs due to potential for additive pharmacological effects
- ibutilide
buprenorphine buccal and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- idelalisib
idelalisib will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- iloperidone
buprenorphine buccal and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- imipramine
buprenorphine buccal and imipramine both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
buprenorphine buccal and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- isocarboxazid
isocarboxazid increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- isoflurane
buprenorphine buccal and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- itraconazole
buprenorphine buccal and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
buprenorphine buccal and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.
- lapatinib
buprenorphine buccal and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.
- lefamulin
buprenorphine buccal and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.
- lenvatinib
buprenorphine buccal and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.
- leuprolide
buprenorphine buccal and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
buprenorphine buccal and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- levorphanol
buprenorphine buccal, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- linezolid
linezolid increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- lithium
buprenorphine buccal and lithium both increase QTc interval. Avoid or Use Alternate Drug.
- lofexidine
buprenorphine buccal and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.
- loperamide
buprenorphine buccal and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
buprenorphine buccal and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
buprenorphine buccal and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- mefloquine
buprenorphine buccal and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.
- meperidine
buprenorphine buccal, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- methadone
buprenorphine buccal, methadone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
buprenorphine buccal and methadone both increase QTc interval. Avoid or Use Alternate Drug. - metoclopramide intranasal
buprenorphine buccal, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- midostaurin
buprenorphine buccal and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
buprenorphine buccal and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- mirtazapine
buprenorphine buccal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
buprenorphine buccal and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.
- morphine
buprenorphine buccal, morphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- moxifloxacin
buprenorphine buccal and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nalbuphine
buprenorphine buccal, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- nilotinib
buprenorphine buccal and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- nortriptyline
buprenorphine buccal and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide
buprenorphine buccal and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- ofloxacin
buprenorphine buccal and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
buprenorphine buccal and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances
- oliceridine
buprenorphine buccal, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.
- olopatadine intranasal
buprenorphine buccal and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
buprenorphine buccal and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- opium tincture
buprenorphine buccal, opium tincture. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- osilodrostat
buprenorphine buccal and osilodrostat both increase QTc interval. Avoid or Use Alternate Drug. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval
- osimertinib
buprenorphine buccal and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
buprenorphine buccal and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- oxycodone
buprenorphine buccal, oxycodone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxymorphone
buprenorphine buccal, oxymorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- ozanimod
ozanimod and buprenorphine buccal both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
buprenorphine buccal and ozanimod both increase QTc interval. Avoid or Use Alternate Drug. - paliperidone
buprenorphine buccal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
buprenorphine buccal and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.
- papaveretum
buprenorphine buccal, papaveretum. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- pasireotide
buprenorphine buccal and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
buprenorphine buccal and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
buprenorphine buccal and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- pentazocine
buprenorphine buccal, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- phenelzine
phenelzine increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- pimavanserin
buprenorphine buccal and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
buprenorphine buccal and pimozide both increase QTc interval. Contraindicated.
- pitolisant
buprenorphine buccal and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
buprenorphine buccal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- primaquine
buprenorphine buccal and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
buprenorphine buccal and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- procarbazine
procarbazine increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Do not use within 14 days of MAOI use. .
- promethazine
buprenorphine buccal and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.
- propafenone
buprenorphine buccal and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- protriptyline
buprenorphine buccal and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- quetiapine
buprenorphine buccal and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
buprenorphine buccal and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- quinine
buprenorphine buccal and quinine both increase QTc interval. Avoid or Use Alternate Drug.
- rasagiline
rasagiline increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- ribociclib
buprenorphine buccal and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.
- rilpivirine
buprenorphine buccal and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.
- risperidone
buprenorphine buccal and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
buprenorphine buccal and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- saquinavir
buprenorphine buccal and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.
- selegiline
selegiline increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Buprenorphine transdermal is not recommended for in patients who have received MAOI within 14 days, because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.
- selegiline transdermal
selegiline transdermal increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
selinexor, buprenorphine buccal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- selpercatinib
buprenorphine buccal and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.
- sertraline
buprenorphine buccal and sertraline both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
buprenorphine buccal and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
buprenorphine buccal and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- sodium oxybate
buprenorphine buccal, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- solifenacin
buprenorphine buccal and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
buprenorphine buccal and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
buprenorphine buccal and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sufentanil
buprenorphine buccal, sufentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- sufentanil SL
buprenorphine buccal decreases effects of sufentanil SL by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of opioid mixed agonist/antagonist or partial agonist may reduce sufentail SL analgesic effect and/or precipitate withdrawal symptoms.
- sunitinib
buprenorphine buccal and sunitinib both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
buprenorphine buccal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.
- tapentadol
buprenorphine buccal, tapentadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- telavancin
buprenorphine buccal and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
buprenorphine buccal and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
buprenorphine buccal and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- tramadol
buprenorphine buccal, tramadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
tramadol, buprenorphine buccal. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent. - tranylcypromine
tranylcypromine increases toxicity of buprenorphine buccal by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- trazodone
buprenorphine buccal and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- triclabendazole
buprenorphine buccal and triclabendazole both increase QTc interval. Avoid or Use Alternate Drug.
- trifluoperazine
buprenorphine buccal and trifluoperazine both decrease QTc interval. Avoid or Use Alternate Drug.
- trimipramine
buprenorphine buccal and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
- triptorelin
buprenorphine buccal and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.
- tucatinib
tucatinib will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- valerian
valerian and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug.
- vandetanib
buprenorphine buccal and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vardenafil
buprenorphine buccal and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
buprenorphine buccal and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- venlafaxine
buprenorphine buccal and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.
- voclosporin
buprenorphine buccal and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.
- voriconazole
buprenorphine buccal and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
- vorinostat
buprenorphine buccal and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
- ziprasidone
buprenorphine buccal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (224)
- albuterol
buprenorphine buccal increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
buprenorphine buccal and albuterol both increase QTc interval. Use Caution/Monitor. - alfentanil
alfentanil and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- alfuzosin
buprenorphine buccal and alfuzosin both increase QTc interval. Use Caution/Monitor.
- alprazolam
alprazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- amitriptyline
buprenorphine buccal and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- amoxapine
buprenorphine buccal and amoxapine both increase sedation. Use Caution/Monitor.
- apalutamide
apalutamide will decrease the level or effect of buprenorphine buccal by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.
- apomorphine
buprenorphine buccal and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
buprenorphine buccal increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
buprenorphine buccal and arformoterol both increase QTc interval. Use Caution/Monitor. - aripiprazole
buprenorphine buccal and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
buprenorphine buccal increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.
- azelastine
azelastine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- belladonna and opium
buprenorphine buccal and belladonna and opium both increase sedation. Use Caution/Monitor.
- benperidol
buprenorphine buccal and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
buprenorphine buccal increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brexanolone
brexanolone, buprenorphine buccal. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- butabarbital
butabarbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- butorphanol
buprenorphine buccal and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
buprenorphine buccal increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbamazepine
carbamazepine decreases levels of buprenorphine buccal by increasing metabolism. Use Caution/Monitor. Carbamazepine increases metabolism of buprenorphine; monitor for decreased efficacy.
carbamazepine will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - carbinoxamine
carbinoxamine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, buprenorphine buccal. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- chlorpromazine
buprenorphine buccal and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- clobazam
buprenorphine buccal, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
buprenorphine buccal and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- clozapine
buprenorphine buccal and clozapine both increase sedation. Use Caution/Monitor.
- codeine
buprenorphine buccal and codeine both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
- crofelemer
crofelemer increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- cyclizine
cyclizine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dantrolene
dantrolene and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- daridorexant
buprenorphine buccal and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darunavir
darunavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Carefully titrate dose when initiating buprenorphine, buprenorphine/naloxone, or methadone with patients taking darunavir/cobicstat. When initiating cobicistat in patients taking buprenorphine, buprenorphine/naloxone, or methadone, adjust dose for buprenorphine, buprenorphine/naloxone, or methadone and monitor clinical signs and symptoms.
- desflurane
desflurane and buprenorphine buccal both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
buprenorphine buccal and desipramine both increase sedation. Use Caution/Monitor.
- dexamethasone
dexamethasone will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- dexfenfluramine
buprenorphine buccal increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
buprenorphine buccal increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
buprenorphine buccal increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
buprenorphine buccal and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
buprenorphine buccal and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- diethylpropion
buprenorphine buccal increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difenoxin hcl
buprenorphine buccal and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
buprenorphine buccal and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
buprenorphine buccal and dipipanone both increase sedation. Use Caution/Monitor.
- dobutamine
buprenorphine buccal increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
buprenorphine buccal increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
buprenorphine buccal increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
buprenorphine buccal and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
buprenorphine buccal and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- droperidol
buprenorphine buccal and droperidol both increase sedation. Use Caution/Monitor.
- efavirenz
efavirenz will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elagolix
elagolix will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- eltrombopag
eltrombopag increases levels of buprenorphine buccal by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- enzalutamide
enzalutamide will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ephedrine
buprenorphine buccal increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
buprenorphine buccal increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
buprenorphine buccal increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- estazolam
estazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- ethanol
buprenorphine buccal and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fenfluramine
buprenorphine buccal increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
buprenorphine buccal and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
buprenorphine buccal and fluphenazine both increase sedation. Use Caution/Monitor.
buprenorphine buccal and fluphenazine both increase QTc interval. Use Caution/Monitor. - flurazepam
flurazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- formoterol
buprenorphine buccal increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fosamprenavir
fosamprenavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .
- fosphenytoin
fosphenytoin will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- gabapentin
gabapentin, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- ganaxolone
buprenorphine buccal and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
buprenorphine buccal and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
buprenorphine buccal and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- iloperidone
buprenorphine buccal and iloperidone both increase sedation. Use Caution/Monitor.
iloperidone increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
buprenorphine buccal and imipramine both increase sedation. Use Caution/Monitor.
- indinavir
indinavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .
- isoproterenol
buprenorphine buccal increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- ketamine
ketamine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
buprenorphine buccal and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, buprenorphine buccal. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, buprenorphine buccal. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- lenacapavir
lenacapavir will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. When initiating buprenorphine while on lenacapavir, use lowest feasible initial or maintenance dose of buprenorphine and carefully titrate dose to desired effect. When initiating lenacapavir while takingmethadone, consider adjusting dose for buprenorphine. Monitor clinical signs and symptoms.
- levalbuterol
buprenorphine buccal increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
buprenorphine buccal and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
buprenorphine buccal increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
buprenorphine buccal and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
buprenorphine buccal and lofexidine both increase sedation. Use Caution/Monitor.
- lopinavir
lopinavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.
- loprazolam
loprazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- loxapine
buprenorphine buccal and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
buprenorphine buccal and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lurasidone
lurasidone, buprenorphine buccal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
buprenorphine buccal and maprotiline both increase sedation. Use Caution/Monitor.
buprenorphine buccal and maprotiline both increase QTc interval. Use Caution/Monitor. - marijuana
buprenorphine buccal and marijuana both increase sedation. Use Caution/Monitor.
- mavacamten
buprenorphine buccal will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- melatonin
buprenorphine buccal and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
buprenorphine buccal and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
buprenorphine buccal and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
buprenorphine buccal increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- methadone
buprenorphine buccal and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
buprenorphine buccal increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
buprenorphine buccal increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
buprenorphine buccal increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
buprenorphine buccal and mirtazapine both increase sedation. Use Caution/Monitor.
- mitotane
buprenorphine buccal decreases levels of mitotane by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
mitotane will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - modafinil
buprenorphine buccal increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
buprenorphine buccal and morphine both increase sedation. Use Caution/Monitor.
- motherwort
buprenorphine buccal and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
buprenorphine buccal and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
buprenorphine buccal and nabilone both increase sedation. Use Caution/Monitor.
- nafcillin
nafcillin will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nalbuphine
buprenorphine buccal and nalbuphine both increase sedation. Use Caution/Monitor.
- nelfinavir
nelfinavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .
- nevirapine
nevirapine will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- norepinephrine
buprenorphine buccal increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
buprenorphine buccal and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
buprenorphine buccal and olanzapine both increase sedation. Use Caution/Monitor.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increases levels of buprenorphine and active metabolite norbuprenorphine; no dose adjustment of buprenorphine is required, but closely monitor for sedation and cognitive effects
- opium tincture
buprenorphine buccal and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- oxycodone
buprenorphine buccal and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
buprenorphine buccal and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
buprenorphine buccal and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
buprenorphine buccal and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
buprenorphine buccal and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
buprenorphine buccal and paroxetine both increase QTc interval. Use Caution/Monitor.
- pegvisomant
buprenorphine buccal decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
buprenorphine buccal and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.
pentobarbital will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - perampanel
perampanel and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- perphenazine
buprenorphine buccal and perphenazine both increase sedation. Use Caution/Monitor.
buprenorphine buccal and perphenazine both increase QTc interval. Use Caution/Monitor. - phendimetrazine
buprenorphine buccal increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.
phenobarbital will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - phentermine
buprenorphine buccal increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
buprenorphine buccal increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
buprenorphine buccal increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pholcodine
buprenorphine buccal and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
buprenorphine buccal and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
buprenorphine buccal increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, buprenorphine buccal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and buprenorphine buccal both increase sedation. Use Caution/Monitor.
primidone will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - prochlorperazine
buprenorphine buccal and prochlorperazine both increase sedation. Use Caution/Monitor.
buprenorphine buccal and prochlorperazine both decrease QTc interval. Use Caution/Monitor. - promethazine
promethazine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- propofol
propofol and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- propylhexedrine
buprenorphine buccal increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
buprenorphine buccal and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- quetiapine
buprenorphine buccal and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
buprenorphine buccal and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
buprenorphine buccal and ranolazine both increase QTc interval. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
buprenorphine buccal and risperidone both increase sedation. Use Caution/Monitor.
- ritonavir
ritonavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.
- rotigotine
buprenorphine buccal and rotigotine both increase sedation. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- salmeterol
buprenorphine buccal increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- saquinavir
saquinavir increases levels of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .
- scullcap
buprenorphine buccal and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- sevoflurane
sevoflurane and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- shepherd's purse
buprenorphine buccal and shepherd's purse both increase sedation. Use Caution/Monitor.
- St John's Wort
St John's Wort will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- sufentanil
buprenorphine buccal and sufentanil both increase sedation. Use Caution/Monitor.
- suvorexant
suvorexant and buprenorphine buccal both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
buprenorphine buccal and tapentadol both increase sedation. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of buprenorphine buccal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- temazepam
temazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- terbutaline
buprenorphine buccal increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
buprenorphine buccal and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
buprenorphine buccal and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
buprenorphine buccal and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
buprenorphine buccal and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
buprenorphine buccal and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- trifluoperazine
buprenorphine buccal and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
buprenorphine buccal and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- xylometazoline
buprenorphine buccal increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
buprenorphine buccal increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
buprenorphine buccal and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
buprenorphine buccal and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
buprenorphine buccal and zotepine both increase sedation. Use Caution/Monitor.
Minor (7)
- brimonidine
brimonidine increases effects of buprenorphine buccal by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- dextroamphetamine
dextroamphetamine increases effects of buprenorphine buccal by unspecified interaction mechanism. Minor/Significance Unknown.
- elvitegravir
elvitegravir increases levels of buprenorphine buccal by unknown mechanism. Minor/Significance Unknown. No dose adjustment of buprenorphine/naloxone is required upon coadministration with VITEKTA. Patients should be closely monitored for sedation and cognitive effects.
- eucalyptus
buprenorphine buccal and eucalyptus both increase sedation. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of buprenorphine buccal by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- sage
buprenorphine buccal and sage both increase sedation. Minor/Significance Unknown.
- ziconotide
ziconotide, buprenorphine buccal. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
Adverse Effects
>10%
Open-label titration phase
- Nausea, opioid-naive (50%)
- Nausea, both opioid-naïve and opioid-tolerant (33%)
- Nausea, opioid-tolerant (17%)
- Constipation, opioid-naïve (13%)
- Constipation, opioid-naïve and opioid-tolerant (11%)
1-10%
Open-label titration phase
- Constipation, opioid-tolerant (8%)
- Headache (8%)
- Vomiting (7%)
- Dizziness (6%)
- Somnolence (6%)
- Drug withdrawal syndrome: (1%)
Postmarketing Reports
Adrenal insufficiency
Hepatotoxicity
Serotonin syndrome
Anaphylaxis
Androgen deficiency
Local reactions (buccal form): Dental decay (including caries, tooth fracture, and tooth loss)
Warnings
Black Box Warnings
Opioid analgesic risk evaluation and mitigation strategy (REMS)
- To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products; under requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers
Healthcare providers are strongly encouraged to:
- Complete a REMS-compliant education program
- Counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products
- Emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist
- Consider other tools to improve patient, household, and community safety
Addiction, abuse, and misuse
- Risk of opioid addiction, abuse, and misuse, which can lead to overdose and death
- Assess each patient’s risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions
Life-threatening respiratory depression
- Serious, life-threatening, or fatal respiratory depression may occur
- Monitor for respiratory depression, especially during initiation or following a dose increase
Accidental exposure
- Accidental exposure of even 1 dose, especially by children, can result in a fatal overdose
Neonatal opioid withdrawal syndrome
- Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts
- Syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high-pitched cry, tremor, vomiting, diarrhea, and failure to gain weight
- Onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn
- If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available
Concomitant use with benzodiazepines or other CNS depressants
- Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to minimum required; and follow patients for signs and symptoms of respiratory depression and sedation
Contraindications
Significant respiratory depression
Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
Known or suspected gastrointestinal obstruction, including paralytic ileus
Hypersensitivity (eg, anaphylaxis) to buprenorphine
Cautions
Misuse, abuse, diversion: Partial agonist at the mu opioid receptor and a schedule III controlled opioid exposes users to the risks of addiction, abuse, and misuse; there is a greater risk for overdose and death with extended-release opioids owing to the larger amount of active opioid present; screen patients for risk of substance use disorders, including opioid abuse and misuse, and warn them of risk for overdose and death associated with use of additional CNS depressants including alcohol and illicit drugs (see Black Box Warnings)
Life-threatening respiratory depression more likely to occur in elderly, cachectic, or debilitated patients as they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients (even to moderate therapeutic doses) (see Black Box Warnings); because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and may be useful to monitor renal function
Neonatal opioid withdrawal syndrome reported with long-term use during pregnancy (see Black Box Warnings)
Accidental exposure reported, including fatalities (see Black Box Warnings)
Interactions with CNS depressants (eg, alcohol, sedatives, anxiolytics, hypnotics, neuroleptics, other opioids) can cause additive effects and increase risk for respiratory depression, profound sedation, and hypotension
Risk of apnea in patients with chronic pulmonary disease; closely monitor these patients, when initiating and titrating therapy; alternatively, consider the use of alternative non-opioid analgesics in these patients (see Black Box Warnings and Contraindications)
Head injury: Respiratory depressant effects of opioids may include carbon dioxide retention and lead to elevated CSF pressure
Hypotensive effects: Can cause severe hypotension; caution with depleted blood volume or coadministration of drugs that affect vasomotor tone (eg, phenothiazines), vasodilators, or antihypertensives
Hepatoxicity: Cases of cytolytic hepatitis and hepatitis with jaundice observed in individuals receiving buprenorphine SL for opioid dependence treatment; increased risk for overdose with moderate or severe hepatic impairment (see Dosage Modifications)
Anaphylactic reactions reported
May cause sphincter of Oddi spasm and aggravate abdominal conditions, including ileus (see Contraindications)
Similar to other opioids, may aggravate seizure disorders by lowering seizure threshold
Patients with cancer who have oral mucositis may absorb buprenorphine more rapidly than intended and have higher plasma levels of buprenorphine (see Dosage Modifications)
Special risk groups may experience increased adverse reactions; caution with alcoholism, delirium tremens, adrenocortical insufficiency, CNS depression, debilitation, kyphoscoliosis associated with respiratory compromise, myxedema or hypothyroidism, prostatic hypertrophy or urethral stricture, severe impairment of hepatic, pulmonary or renal function, and toxic psychosis
Profound sedation, respiratory depression, coma, and death may result from concomitant use with other CNS depressants (see BBW); prescribe lowest effective dosages and minimum durations of concomitant use
If an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response; follow patients closely for signs and symptoms of respiratory depression and sedation; if concomitant use with benzodiazepine is warranted, consider prescribing naloxone for the emergency treatment of opioid overdose
Due to risk of respiratory depression with concomitant use of skeletal muscle relaxants and opioids, consider prescribing naloxone for the emergency treatment of opioid overdose
Cases of adrenal insufficiency reported with opioid use, more often following greater than one month of use; symptoms may include nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure; if adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids; wean patient off of opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers; other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency
Chronic use of opioids may cause reduced fertility in females and males of reproductive potential; unknown whether effects on fertility are reversible
Increased risk of dental problems
- On January 12, 2022, FDA warned of potential dental problems associated with transmucosal buprenorphine-containing products (eg, buccal, sublingual)
- Cases of dental caries, some severe (eg, tooth fracture, tooth loss), reported following use of transmucosal buprenorphine-containing products; reported events include cavities, tooth decay, dental abscesses/infection, rampant caries, tooth erosion, fillings falling out, and, in some cases, total tooth loss
- Treatment for these events included tooth extraction, root canal, dental surgery, as well as other restorative procedures (eg, fillings, crowns, implants, dentures); multiple cases were reported in individuals without any prior history of dental problems
- Despite these risks, buprenorphine is an important treatment option for opioid use disorder and pain, and the benefits of these medicines clearly outweigh the risks
- Review patient’s health before initiating with transmucosal buprenorphine;
- Refer patients to dental care services and encourage them to have regular dental checkups while receiving therapy; educate patients to seek dental care and strategies to maintain or improve oral health while being treated with transmucosal buprenorphine-containing products
- Strategies include, but are not limited to, gently rinsing teeth and gums with water and then swallowing after completely dissolved in oral mucosa; advise patients to wait for at least one hour after taking drug before brushing teeth
- Counsel patients regarding potential for dental problems and importance of taking extra steps after the medicine has completely dissolved, including gently rinsing teeth and gums with water and then swallow; advise to wait at least 1 hour before brushing their teeth
- Dentists treating patients taking transmucosal buprenorphine should perform a baseline dental evaluation and caries risk assessment, establish a dental caries preventive plan, and encourage regular dental checkups
Opioid analgesic risk evaluation and mitigation strategy (REMS)
- To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a Risk Evaluation and Mitigation Strategy (REMS) for these products
- Discuss the safe use, serious risks, and proper storage and disposal of opioid analgesics with patients and/or their caregivers every time these medicines are prescribed; use the following link to obtain the Patient Counseling Guide (PCG): www.fda.gov/OpioidAnalgesicREMSPCG
- Emphasize to patients and their caregivers the importance of reading the Medication Guide that they will receive from their pharmacist every time an opioid analgesic is dispensed to them
- Consider using other tools to improve patient, household, and community safety, such as patient-prescriber agreements that reinforce patient-prescriber responsibilities
- To obtain further information on opioid analgesic REMS and for a list of accredited REMS CME/CE, call 1-800-503-0784, or log on to www.opioidanalgesicrems.com; the FDA Blueprint can be found at www.fda.gov/OpioidAnalgesicREMSBlueprint
Patient access to naloxone for emergency treatment of opioid overdose
- Assess potential need for naloxone; consider prescribing for emergency treatment of opioid overdose
- Consult on availability and ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing requirements or guidelines
- Educate patients regarding the signs and symptoms of respiratory depression and to call 911 or seek immediate emergency medical help in the event of a known or suspected overdose
QTc prolongation
- QTc prolongation observed in healthy individuals at 40 mcg/hr; avoid in patients with history of long QT syndrome or coadministration with class IA (eg, quinidine, procainamide, disopyramide) or class III (eg, sotalol, amiodarone, dofetilide) antiarrhythmics
- Thorough QT studies with buprenorphine products have demonstrated QT prolongation less than or equal to 15 msec; this QTc prolongation effect does not appear to be mediated by hERG channels; based on these two findings, buprenorphine is unlikely to be pro-arrhythmic when used alone in patients without risk factors; the risk of combining buprenorphine with other QT-prolonging agents is not known
- Consider these observations in clinical decisions when prescribing this medication to patients with risk factors such as hypokalemia, bradycardia, recent conversion from atrial fibrillation, congestive heart failure, digitalis therapy, baseline QT prolongation, subclinical long-QT syndrome, or severe hypomagnesemia
Pregnancy & Lactation
Pregnancy
Opioids cross the placenta and may produce respiratory depression and psychophysiologic effects in neonates; not recommended for use in women immediately prior to and during labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate
Neonates whose mothers have been taking opioids long term may also exhibit withdrawal signs, either at birth and/or in the nursery, because they have developed physical dependence; neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening and should be treated according to protocols developed by neonatology experts
Lactation
Caution should be exercised when therapy is administered to nursing women; the developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Elicits partial agonistic effects at the mu opioid receptor in the CNS, and antagonistic effects at the kappa opioid receptor
Absorption
Absolute bioavailability: 46-65%
75-mcg single dose
- Peak plasma concentration: 0.17 ng/mL
- Peak plasma time: 3 hr
- AUC (0-4 hr): 0.46 h·ng/mL
- AUC (1 - ∞): 0.63 h·ng/mL
300-mcg single dose
- Peak plasma concentration: 0.47 ng/mL
- Peak plasma time: 2.5 hr
- AUC (0-4 hr): 2 h·ng/mL
- AUC (1 - ∞): 2.3 h·ng/mL
1200-mcg single dose
- Peak plasma concentration: 1.43 ng/mL
- Peak plasma time: 3 hr
- AUC (0-4 hr): 9.6 h·ng/mL
- AUC (1 - ∞): 10.5 h·ng/mL
Food and beverage decrease systemic exposure
- Systemic exposure to buprenorphine was reduced by 23-27% by the ingestion of liquids (cold, hot, and room temperature water) during film administration
- Systemic exposure also reduced if coadministration with low pH liquid (eg, decaffeinated cola) by ~37%
- The consumption of food and liquids should be avoided until the buccal film has completely dissolved
Distribution
Protein bound 96%; primarily to alpha and beta globulin
Metabolism
Undergoes both N-dealkylation to norbuprenorphine and glucuronidation
The N-dealkylation pathway is mediated primarily by CYP3A4
Norbuprenorphine, the major metabolite, can further undergo glucuronidation
Elimination
Half-life: 27.6 hr
Excretion: 30% urine; 69% feces
Administration
Instructions
Instruct patients not to use if the pouch seal is broken or the buccal film is cut, damaged, or changed in any way
Buccal film for oral buccal use only; apply to buccal mucosa q12hr
Do not apply to areas of the mouth with any open sores or lesions
Monitor patients closely for respiratory depression, especially within the first 24-72 hr after initiating therapy and following dosage increases; adjust the dosage accordingly
Also see Adult Dosing for titration and maintenance dosing
Buccal Application
First, the patient must use the tongue to wet the inside of the cheek or rinse the mouth with water to wet the area for placement of buprenorphine buccal
Buprenorphine is then applied immediately after removal from the individually sealed package
The yellow side of the Belbuca film is placed against the inside of the cheek; the entire film is held in place with clean, dry fingers for 5 seconds and then left in place on the inside of the cheek until fully dissolved
The buccal film adheres to the moist buccal mucosa and will completely dissolve after application, usually within 30 minutes
The film should not be manipulated with the tongue or finger(s)
Avoid eating food and drinking liquids until the film has dissolved
A buprenorphine buccal film that is chewed or swallowed may result in lower peak concentrations and lower bioavailability than when used as directed
Discontinuation
When a patient no longer requires therapy with buprenorphine buccal, use a gradual downward titration of the dose to prevent signs and symptoms of withdrawal in the physically dependent patient
Do not abruptly discontinue
Storage
Store at controlled room temperature (25°C [77°F]); excursions permitted to 15-30°C (59-86ºF)
Advise patients to store buprenorphine-containing medications safely and out of sight and reach of children
Images
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
