buprenorphine (Rx)

Moderate-to-Severe Pain

0.3 mg IV/IM q6hr; may be repeated once (up to 0.3 mg) if required 30-60 minutes after initial dose

Also see Administration

Opioid Dependence

Induction (sublingual tablet)

• 8 mg SL on day 1, then 16 mg SL on day 2; continued over 3-4 days

Maintenance (buprenorphine-naloxone combination)

• Switch to buprenorphine/naloxone combination for unsupervised maintenance
• For dosing, see drug monograph for buprenorphine/naloxone

Dosage Modifications

Renal impairment

• No differences in pharmacokinetics observed between 9 dialysis-dependent and 6 normal patients following IV administration of 0.3 mg buprenorphine
• Renal failure: Pharmacokinetics are unknown

Hepatic impairment

• SL use

  • Mild: No dose adjustment is needed
  • Moderate: No dose adjustment is necessary, closely monitor for signs and symptoms of toxicity or overdose
  • Severe: Reducing starting and titration incremental dose by half, and monitor for signs and symptoms of toxicity or overdose

• IV/IM use

  • Mild-to-moderate: No dosage adjustments provided
  • Severe: No dosage adjustment provided; use with caution

Dosing Considerations

For prescriber qualifications, see prescribing information

Also given in combination with naloxone

Induction with SL tablets

• Patients dependent on heroin or other short-acting opioids

  • At initiation, administer first dose of buprenorphine SL tablets only when signs/symptoms of moderate opioid withdrawal appear, and ≥4 hr after patient last used an opioid
  • Titrate to clinical effectiveness achieved as rapidly as possible; dosing on the initial day of treatment may be given in 2-4 mg increments if preferred

• Patients dependent on methadone or other long-acting opioids

  • Administer first dose of buprenorphine sublingual tablets should when clear signs/symptoms of moderate opioid withdrawal appear, and generally ≥24 hr after the patient last used a long-acting opioids

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 differ on how 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)

Moderate-to-Severe Pain

<2 years: Safety and efficacy not established

2-12 years: 2-6 mcg/kg IV/IM q4-6hr PRN  

>12 years: 0.3 mg IV/IM q6hr; may be repeated once (up to 0.3 mg) if required 30-60 minutes after initial dose

Also see Administration

Moderate-to-Severe Pain

0.15 mg IV/IM q6hr; titrate slowly due to increase risk of respiratory depression

Contraindicated (5)

• alvimopan

  alvimopan, buprenorphine. receptor binding competition. Contraindicated. Alvimopan is 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. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

• dronedarone

  buprenorphine and dronedarone both increase QTc interval. Contraindicated.

• fezolinetant

  buprenorphine 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

• lefamulin

  lefamulin will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• thioridazine

  buprenorphine and thioridazine both increase QTc interval. Contraindicated.

Serious - Use Alternative (206)

• acrivastine

  acrivastine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• alfentanil

  buprenorphine, 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.

• alfuzosin

  alfuzosin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• amiodarone

  buprenorphine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
  
  amisulpride and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• amitriptyline

  buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• amoxapine

  buprenorphine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.

• anagrelide

  anagrelide and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of buprenorphine 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

  apomorphine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• aripiprazole

  aripiprazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• arsenic trioxide

  buprenorphine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  artemether/lumefantrine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  asenapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
  
  asenapine and buprenorphine 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 both increase QTc interval. Avoid or Use Alternate Drug.
  
  asenapine transdermal and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• atomoxetine

  atomoxetine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• avapritinib

  avapritinib and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• azithromycin

  buprenorphine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• bedaquiline

  bedaquiline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• belladonna and opium

  buprenorphine, 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

  benzhydrocodone/acetaminophen, buprenorphine. 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.
  
  buprenorphine 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 both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• bremelanotide

  bremelanotide will decrease the level or effect of buprenorphine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexpiprazole

  brexpiprazole and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• brimonidine

  brimonidine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• brivaracetam

  brivaracetam and buprenorphine 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 both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• butorphanol

  buprenorphine, 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, 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

  ceritinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloramphenicol

  chloramphenicol will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloroquine

  chloroquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  buprenorphine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

• cimetidine

  cimetidine increases effects of buprenorphine by decreasing metabolism. Avoid or Use Alternate Drug.

• ciprofloxacin

  buprenorphine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clarithromycin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  buprenorphine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clonidine

  clonidine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• clozapine

  clozapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• codeine

  buprenorphine, 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.

• conivaptan

  conivaptan will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• crizotinib

  crizotinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• dasatinib

  dasatinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• degarelix

  degarelix and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  desflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  buprenorphine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• dextromoramide

  buprenorphine, 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, 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. 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, 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, 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, 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 and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

• dofetilide

  buprenorphine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  dolasetron and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  donepezil and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  doxepin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• efavirenz

  efavirenz and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• eliglustat

  buprenorphine and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.

• eluxadoline

  buprenorphine, 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

  encorafenib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  entrectinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• eribulin

  eribulin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  buprenorphine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  buprenorphine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  buprenorphine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  buprenorphine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  buprenorphine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• fentanyl

  fentanyl, buprenorphine. 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.
  
  buprenorphine 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 intranasal

  fentanyl intranasal, buprenorphine. 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.
  
  buprenorphine 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 transdermal

  fentanyl transdermal, buprenorphine. 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.
  
  buprenorphine 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 transmucosal

  fentanyl transmucosal, buprenorphine. 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.
  
  buprenorphine 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.

• fexinidazole

  fexinidazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  fingolimod and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• flecainide

  buprenorphine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

• fluconazole

  buprenorphine and fluconazole both increase QTc interval. Contraindicated.

• fluoxetine

  buprenorphine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.

• fluvoxamine

  buprenorphine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.

• foscarnet

  buprenorphine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

• fostemsavir

  buprenorphine and fostemsavir both increase QTc interval. Avoid or Use Alternate Drug.

• gemifloxacin

  gemifloxacin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• gemtuzumab

  buprenorphine and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  buprenorphine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

• goserelin

  buprenorphine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

• granisetron

  granisetron and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• haloperidol

  buprenorphine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• histrelin

  buprenorphine and histrelin both increase QTc interval. Avoid or Use Alternate Drug.

• hydrocodone

  buprenorphine 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. .
  
  hydrocodone, buprenorphine. 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.

• hydromorphone

  buprenorphine, 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 and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

• ibutilide

  buprenorphine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of buprenorphine 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 and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

• imipramine

  buprenorphine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.

• inotuzumab

  buprenorphine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

• isocarboxazid

  isocarboxazid increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• isoflurane

  isoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• itraconazole

  itraconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  itraconazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
  
  buprenorphine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

• ketoconazole

  ketoconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lapatinib

  buprenorphine and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

• lefamulin

  buprenorphine and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

• lenvatinib

  buprenorphine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.

• leuprolide

  buprenorphine and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.

• levofloxacin

  buprenorphine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• levoketoconazole

  levoketoconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• levorphanol

  buprenorphine, 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 by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• lithium

  lithium and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• lofexidine

  buprenorphine and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.

• lonafarnib

  lonafarnib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

• loperamide

  buprenorphine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

• lopinavir

  buprenorphine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

• macimorelin

  buprenorphine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.

• mefloquine

  buprenorphine and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

• meperidine

  buprenorphine, 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, 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 and methadone both increase QTc interval. Avoid or Use Alternate Drug.

• methylene blue

  methylene blue and buprenorphine both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

• metoclopramide intranasal

  buprenorphine, 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 and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

• mifepristone

  mifepristone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  buprenorphine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  buprenorphine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.

• morphine

  buprenorphine, 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 and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nalbuphine

  buprenorphine, 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.

• nefazodone

  nefazodone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nilotinib

  buprenorphine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• nortriptyline

  buprenorphine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  buprenorphine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  buprenorphine and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  olanzapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. If concurrent use of olanzapine and buprenorphine is necessary, consider dose reduction of one or both drugs.

• oliceridine

  buprenorphine, 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 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 and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.

• opium tincture

  buprenorphine, 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.

• osimertinib

  buprenorphine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.

• oxaliplatin

  oxaliplatin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• oxycodone

  buprenorphine, 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, 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 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 and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.

• paliperidone

  buprenorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

• panobinostat

  buprenorphine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

• papaveretum

  buprenorphine, 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 and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.

• pazopanib

  buprenorphine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

• pentamidine

  buprenorphine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

• pentazocine

  buprenorphine, 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 by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• pimavanserin

  buprenorphine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

• pimozide

  buprenorphine and pimozide both increase QTc interval. Contraindicated.

• pitolisant

  buprenorphine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• ponesimod

  buprenorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  posaconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  buprenorphine and posaconazole both increase QTc interval. Contraindicated.

• primaquine

  primaquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• procainamide

  buprenorphine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

• procarbazine

  procarbazine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Do not use within 14 days of MAOI use. .

• promethazine

  buprenorphine and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.

• propafenone

  buprenorphine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

• protriptyline

  buprenorphine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• quetiapine

  buprenorphine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.

• quinidine

  buprenorphine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.

• quinine

  buprenorphine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• ribociclib

  buprenorphine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.

• rilpivirine

  buprenorphine and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.

• risperidone

  buprenorphine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

• romidepsin

  buprenorphine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

• saquinavir

  buprenorphine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.

• selegiline

  selegiline increases toxicity of buprenorphine 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 by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• selinexor

  selinexor, buprenorphine. 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 and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.

• sertraline

  sertraline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  sevoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  siponimod and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  buprenorphine, 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

  solifenacin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• sorafenib

  buprenorphine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.

• sotalol

  buprenorphine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

• sufentanil

  buprenorphine, 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 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.
  
  sufentanil SL, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. 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.

• sunitinib

  sunitinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• tacrolimus

  tacrolimus and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• tapentadol

  buprenorphine, 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 and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

• tetrabenazine

  buprenorphine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

• toremifene

  buprenorphine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.

• tramadol

  tramadol, buprenorphine. 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.
  
  buprenorphine, 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.

• tranylcypromine

  tranylcypromine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• trazodone

  buprenorphine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

• triclabendazole

  buprenorphine and triclabendazole both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  buprenorphine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• triptorelin

  buprenorphine and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.

• tucatinib

  tucatinib will increase the level or effect of buprenorphine 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 both increase sedation. Avoid or Use Alternate Drug.

• vandetanib

  buprenorphine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.

• vardenafil

  buprenorphine and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.

• vemurafenib

  buprenorphine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

• venlafaxine

  buprenorphine and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.

• voclosporin

  buprenorphine and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

• voriconazole

  voriconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  buprenorphine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  vorinostat and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.

• voxelotor

  voxelotor will increase the level or effect of buprenorphine 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 and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (217)

• albuterol

  buprenorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and buprenorphine both increase QTc interval. Use Caution/Monitor.

• alfentanil

  alfentanil and buprenorphine both increase sedation. Use Caution/Monitor.

• alprazolam

  alprazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• amitriptyline

  buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and buprenorphine both increase sedation. Use Caution/Monitor.
  
  amobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amoxapine

  buprenorphine and amoxapine both increase sedation. Use Caution/Monitor.

• apalutamide

  apalutamide will decrease the level or effect of buprenorphine by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.

• apomorphine

  buprenorphine and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  arformoterol and buprenorphine both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  buprenorphine and aripiprazole both increase sedation. Use Caution/Monitor.

• armodafinil

  buprenorphine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• atazanavir

  atazanavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.

• azelastine

  azelastine and buprenorphine both increase sedation. Use Caution/Monitor.

• baclofen

  baclofen and buprenorphine both increase sedation. Use Caution/Monitor.

• belladonna and opium

  buprenorphine and belladonna and opium both increase sedation. Use Caution/Monitor.

• belzutifan

  belzutifan will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• benperidol

  buprenorphine and benperidol both increase sedation. Use Caution/Monitor.

• benzphetamine

  buprenorphine 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 by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• brexanolone

  brexanolone, buprenorphine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  buprenorphine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• butabarbital

  butabarbital and buprenorphine both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and buprenorphine both increase sedation. Use Caution/Monitor.

• butorphanol

  buprenorphine and butorphanol both increase sedation. Use Caution/Monitor.

• carbamazepine

  carbamazepine decreases levels of buprenorphine by increasing metabolism. Use Caution/Monitor. Carbamazepine increases metabolism of buprenorphine; monitor for decreased efficacy.
  
  carbamazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and buprenorphine both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and buprenorphine both increase sedation. Use Caution/Monitor.

• cenobamate

  cenobamate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
  
  cenobamate, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and buprenorphine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and buprenorphine both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  buprenorphine and chlorpromazine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and buprenorphine both increase sedation. Use Caution/Monitor.

• cinnarizine

  cinnarizine and buprenorphine both increase sedation. Use Caution/Monitor.

• clemastine

  clemastine and buprenorphine both increase sedation. Use Caution/Monitor.

• clobazam

  buprenorphine, 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 and clomipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and buprenorphine both increase sedation. Use Caution/Monitor.

• clozapine

  buprenorphine and clozapine both increase sedation. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• codeine

  buprenorphine and codeine both increase sedation. Use Caution/Monitor.

• crizotinib

  crizotinib increases levels of buprenorphine 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 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 both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and buprenorphine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and buprenorphine both increase sedation. Use Caution/Monitor.

• dabrafenib

  dabrafenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dantrolene

  dantrolene and buprenorphine both increase sedation. Use Caution/Monitor.

• daridorexant

  buprenorphine 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 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 both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

• desipramine

  buprenorphine and desipramine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  buprenorphine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and buprenorphine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  dexamethasone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dexchlorpheniramine

  dexchlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  buprenorphine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  dexmedetomidine and buprenorphine both increase sedation. Use Caution/Monitor.

• dextromoramide

  buprenorphine and dextromoramide both increase sedation. Use Caution/Monitor.

• diamorphine

  buprenorphine and diamorphine both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• difelikefalin

  difelikefalin and buprenorphine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  buprenorphine and difenoxin hcl both increase sedation. Use Caution/Monitor.

• dimenhydrinate

  dimenhydrinate and buprenorphine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and buprenorphine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  buprenorphine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

• dipipanone

  buprenorphine and dipipanone both increase sedation. Use Caution/Monitor.

• dopexamine

  buprenorphine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  buprenorphine and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  buprenorphine and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and buprenorphine both increase sedation. Use Caution/Monitor.

• droperidol

  buprenorphine and droperidol both increase sedation. Use Caution/Monitor.

• efavirenz

  efavirenz will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• elagolix

  elagolix will decrease the level or effect of buprenorphine 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.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of buprenorphine 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.

• encorafenib

  encorafenib, buprenorphine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

• enzalutamide

  enzalutamide will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, buprenorphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• estazolam

  estazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• ethanol

  buprenorphine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and buprenorphine both increase sedation. Use Caution/Monitor.

• etravirine

  etravirine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fedratinib

  fedratinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• fenfluramine

  buprenorphine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• flibanserin

  buprenorphine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

• fluphenazine

  buprenorphine and fluphenazine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and fluphenazine both increase QTc interval. Use Caution/Monitor.

• flurazepam

  flurazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• fosamprenavir

  fosamprenavir increases levels of buprenorphine 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 by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• gabapentin

  gabapentin, buprenorphine. 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. 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 and ganaxolone both increase sedation. Use Caution/Monitor.

• haloperidol

  buprenorphine and haloperidol both increase sedation. Use Caution/Monitor.

• hydromorphone

  buprenorphine and hydromorphone both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and buprenorphine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and buprenorphine both increase QTc interval. Modify Therapy/Monitor Closely. If coadministration necessary, consider consider dose reduction of one or both drugs due to potential for additive pharmacological effects

• iloperidone

  buprenorphine and iloperidone both increase sedation. Use Caution/Monitor.
  
  iloperidone increases levels of buprenorphine 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 and imipramine both increase sedation. Use Caution/Monitor.

• indinavir

  indinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .

• istradefylline

  istradefylline will increase the level or effect of buprenorphine 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 both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  buprenorphine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lasmiditan

  lasmiditan, buprenorphine. 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. 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 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 taking buprenorphine, consider adjusting dose for buprenorphine. Monitor clinical signs and symptoms.

• letermovir

  letermovir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levorphanol

  buprenorphine and levorphanol both increase sedation. Use Caution/Monitor.

• lofepramine

  buprenorphine and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  buprenorphine and lofexidine both increase sedation. Use Caution/Monitor.

• lopinavir

  lopinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.

• loprazolam

  loprazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• lorlatinib

  lorlatinib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lormetazepam

  lormetazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• loxapine

  buprenorphine and loxapine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  buprenorphine and loxapine inhaled both increase sedation. Use Caution/Monitor.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lurasidone

  lurasidone, buprenorphine. 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 and maprotiline both increase sedation. Use Caution/Monitor.
  
  buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor.

• marijuana

  buprenorphine and marijuana both increase sedation. Use Caution/Monitor.

• mavacamten

  buprenorphine 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 and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  buprenorphine and meperidine both increase sedation. Use Caution/Monitor.

• meprobamate

  buprenorphine and meprobamate both increase sedation. Use Caution/Monitor.

• metaxalone

  metaxalone and buprenorphine both increase sedation. Use Caution/Monitor.

• methadone

  buprenorphine and methadone both increase sedation. Use Caution/Monitor.

• methocarbamol

  methocarbamol and buprenorphine both increase sedation. Use Caution/Monitor.

• methylenedioxymethamphetamine

  buprenorphine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midazolam

  midazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, buprenorphine. 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.

• mirtazapine

  buprenorphine and mirtazapine both increase sedation. Use Caution/Monitor.

• mitotane

  mitotane will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• morphine

  buprenorphine and morphine both increase sedation. Use Caution/Monitor.

• motherwort

  buprenorphine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  buprenorphine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  buprenorphine and nabilone both increase sedation. Use Caution/Monitor.

• nafcillin

  nafcillin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nalbuphine

  buprenorphine and nalbuphine both increase sedation. Use Caution/Monitor.

• nelfinavir

  nelfinavir increases levels of buprenorphine 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 by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nortriptyline

  buprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.

• olanzapine

  buprenorphine and olanzapine both increase sedation. Use Caution/Monitor.

• oliceridine

  oliceridine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. 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.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of buprenorphine 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 and opium tincture both increase sedation. Use Caution/Monitor.

• orphenadrine

  orphenadrine and buprenorphine both increase sedation. Use Caution/Monitor.

• osilodrostat

  osilodrostat and buprenorphine both increase QTc interval. Use Caution/Monitor.

• oxazepam

  oxazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• oxycodone

  buprenorphine and oxycodone both increase sedation. Use Caution/Monitor.

• oxymorphone

  buprenorphine and oxymorphone both increase sedation. Use Caution/Monitor.

• paliperidone

  buprenorphine and paliperidone both increase sedation. Use Caution/Monitor.

• papaveretum

  buprenorphine and papaveretum both increase sedation. Use Caution/Monitor.

• papaverine

  buprenorphine and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  buprenorphine and paroxetine both increase QTc interval. Use Caution/Monitor.

• pegvisomant

  buprenorphine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

• pentazocine

  buprenorphine and pentazocine both increase sedation. Use Caution/Monitor.

• pentobarbital

  pentobarbital and buprenorphine both increase sedation. Use Caution/Monitor.
  
  pentobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• perampanel

  perampanel and buprenorphine both increase sedation. Use Caution/Monitor.

• perphenazine

  buprenorphine and perphenazine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and perphenazine both increase QTc interval. Use Caution/Monitor.

• phenobarbital

  phenobarbital and buprenorphine both increase sedation. Use Caution/Monitor.
  
  phenobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• phenylephrine PO

  buprenorphine 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 by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pholcodine

  buprenorphine and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  buprenorphine and pimozide both increase sedation. Use Caution/Monitor.

• pregabalin

  pregabalin, buprenorphine. 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 both increase sedation. Use Caution/Monitor.
  
  primidone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• prochlorperazine

  buprenorphine and prochlorperazine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

• promethazine

  promethazine and buprenorphine both increase sedation. Use Caution/Monitor.

• propofol

  propofol and buprenorphine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  buprenorphine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  buprenorphine and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  quazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• quetiapine

  buprenorphine and quetiapine both increase sedation. Use Caution/Monitor.

• ramelteon

  buprenorphine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  buprenorphine and ranolazine both increase QTc interval. Use Caution/Monitor.

• remimazolam

  remimazolam, buprenorphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  ribociclib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifabutin

  rifabutin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  rifapentine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• risperidone

  buprenorphine and risperidone both increase sedation. Use Caution/Monitor.

• ritonavir

  ritonavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.

• rolapitant

  rolapitant will increase the level or effect of buprenorphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• rucaparib

  rucaparib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• saquinavir

  saquinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .

• scullcap

  buprenorphine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and buprenorphine both increase sedation. Use Caution/Monitor.
  
  secobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of buprenorphine

• sevoflurane

  sevoflurane and buprenorphine both increase sedation. Use Caution/Monitor.

• shepherd's purse

  buprenorphine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of buprenorphine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of buprenorphine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.

• St John's Wort

  St John's Wort will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  stiripentol, buprenorphine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  buprenorphine and sufentanil both increase sedation. Use Caution/Monitor.

• suvorexant

  suvorexant and buprenorphine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tapentadol

  buprenorphine and tapentadol both increase sedation. Use Caution/Monitor.

• tazemetostat

  tazemetostat will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  tecovirimat will decrease the level or effect of buprenorphine 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 both increase sedation. Use Caution/Monitor.

• thioridazine

  buprenorphine and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  buprenorphine and thiothixene both increase sedation. Use Caution/Monitor.

• tipranavir

  tipranavir will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• topiramate

  buprenorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  buprenorphine and tramadol both increase sedation. Use Caution/Monitor.

• trazodone

  buprenorphine and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• triclofos

  triclofos and buprenorphine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  buprenorphine and trifluoperazine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and trifluoperazine both decrease QTc interval. Use Caution/Monitor.

• trimipramine

  buprenorphine and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and buprenorphine both increase sedation. Use Caution/Monitor.

• valbenazine

  valbenazine and buprenorphine both increase QTc interval. Use Caution/Monitor.

• xylometazoline

  buprenorphine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  buprenorphine and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  buprenorphine and ziprasidone both increase sedation. Use Caution/Monitor.

• zotepine

  buprenorphine and zotepine both increase sedation. Use Caution/Monitor.

Minor (11)

• acetazolamide

  acetazolamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• anastrozole

  anastrozole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• brimonidine

  brimonidine increases effects of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dextroamphetamine

  dextroamphetamine increases effects of buprenorphine by unspecified interaction mechanism. Minor/Significance Unknown.

• elvitegravir

  elvitegravir increases levels of buprenorphine 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 and eucalyptus both increase sedation. Minor/Significance Unknown.

• larotrectinib

  larotrectinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lidocaine

  lidocaine increases toxicity of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

• sage

  buprenorphine and sage both increase sedation. Minor/Significance Unknown.

• ziconotide

  ziconotide, buprenorphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• acrivastine

  Serious - Use Alternative (1)acrivastine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• albuterol

  Monitor Closely (2)buprenorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and buprenorphine both increase QTc interval. Use Caution/Monitor.

• alfentanil

  Monitor Closely (1)alfentanil and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• alfuzosin

  Serious - Use Alternative (1)alfuzosin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• alprazolam

  Monitor Closely (1)alprazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• alvimopan

  Contraindicated (1)alvimopan, buprenorphine. receptor binding competition. Contraindicated. Alvimopan is 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. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

• amiodarone

  Serious - Use Alternative (1)buprenorphine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Serious - Use Alternative (2)amisulpride and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
  
  amisulpride and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• amitriptyline

  Monitor Closely (1)buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (2)amobarbital and buprenorphine both increase sedation. Use Caution/Monitor.
  
  amobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amoxapine

  Monitor Closely (1)buprenorphine and amoxapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.

• anagrelide

  Serious - Use Alternative (2)anagrelide and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• apalutamide

  Monitor Closely (1)apalutamide will decrease the level or effect of buprenorphine by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.Serious - Use Alternative (1)apalutamide will decrease the level or effect of buprenorphine 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

  Monitor Closely (1)buprenorphine and apomorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)apomorphine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• arformoterol

  Monitor Closely (1)arformoterol and buprenorphine both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (1)buprenorphine and aripiprazole both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• armodafinil

  Monitor Closely (1)buprenorphine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• arsenic trioxide

  Serious - Use Alternative (1)buprenorphine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  Serious - Use Alternative (1)artemether and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (1)artemether/lumefantrine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  Serious - Use Alternative (3)asenapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
  
  asenapine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• asenapine transdermal

  Serious - Use Alternative (2)asenapine transdermal and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  asenapine transdermal and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• atazanavir

  Monitor Closely (1)atazanavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.

• atomoxetine

  Serious - Use Alternative (1)atomoxetine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• avapritinib

  Serious - Use Alternative (1)avapritinib and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• azelastine

  Monitor Closely (1)azelastine and buprenorphine both increase sedation. Use Caution/Monitor.

• azithromycin

  Serious - Use Alternative (1)buprenorphine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

• baclofen

  Monitor Closely (1)baclofen and buprenorphine both increase sedation. Use Caution/Monitor.

• bedaquiline

  Serious - Use Alternative (1)bedaquiline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• belladonna and opium

  Monitor Closely (1)buprenorphine and belladonna and opium both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• belzutifan

  Monitor Closely (1)belzutifan will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• benperidol

  Monitor Closely (1)buprenorphine and benperidol both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Serious - Use Alternative (3)benzhydrocodone/acetaminophen, buprenorphine. 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.
  
  buprenorphine 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 both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

  Monitor Closely (1)buprenorphine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bosentan

  Monitor Closely (1)bosentan will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of buprenorphine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexanolone

  Monitor Closely (1)brexanolone, buprenorphine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  Serious - Use Alternative (1)brexpiprazole and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• brimonidine

  Serious - Use Alternative (1)brimonidine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateMinor (1)brimonidine increases effects of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• brivaracetam

  Serious - Use Alternative (1)brivaracetam and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• brompheniramine

  Monitor Closely (1)brompheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  Serious - Use Alternative (1)buprenorphine subdermal implant and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection

  Monitor Closely (1)buprenorphine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• butabarbital

  Monitor Closely (1)butabarbital and buprenorphine both increase sedation. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital and buprenorphine both increase sedation. Use Caution/Monitor.

• butorphanol

  Monitor Closely (1)buprenorphine and butorphanol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Serious - Use Alternative (1)buprenorphine, 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.

• carbamazepine

  Monitor Closely (2)carbamazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  carbamazepine decreases levels of buprenorphine by increasing metabolism. Use Caution/Monitor. Carbamazepine increases metabolism of buprenorphine; monitor for decreased efficacy.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and buprenorphine both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and buprenorphine both increase sedation. Use Caution/Monitor.

• cenobamate

  Monitor Closely (2)cenobamate, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• ceritinib

  Serious - Use Alternative (2)ceritinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and buprenorphine both increase sedation. Use Caution/Monitor.

• chloramphenicol

  Serious - Use Alternative (1)chloramphenicol will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and buprenorphine both increase sedation. Use Caution/Monitor.

• chloroquine

  Serious - Use Alternative (1)chloroquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)buprenorphine and chlorpromazine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and buprenorphine both increase sedation. Use Caution/Monitor.

• cimetidine

  Serious - Use Alternative (1)cimetidine increases effects of buprenorphine by decreasing metabolism. Avoid or Use Alternate Drug.

• cinnarizine

  Monitor Closely (1)cinnarizine and buprenorphine both increase sedation. Use Caution/Monitor.

• ciprofloxacin

  Serious - Use Alternative (1)buprenorphine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  Serious - Use Alternative (1)citalopram and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (2)clarithromycin will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clarithromycin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine and buprenorphine both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (1)buprenorphine, 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

  Monitor Closely (1)buprenorphine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

• clonazepam

  Monitor Closely (1)clonazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)clonidine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• clorazepate

  Monitor Closely (1)clorazepate and buprenorphine both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (1)buprenorphine and clozapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• cobicistat

  Monitor Closely (1)cobicistat will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• codeine

  Monitor Closely (1)buprenorphine and codeine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• conivaptan

  Serious - Use Alternative (1)conivaptan will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• crizotinib

  Monitor Closely (1)crizotinib increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.Serious - Use Alternative (1)crizotinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• crofelemer

  Monitor Closely (1)crofelemer increases levels of buprenorphine 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

  Monitor Closely (1)cyclizine and buprenorphine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (1)cyclobenzaprine and buprenorphine both increase sedation. Use Caution/Monitor.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and buprenorphine both increase sedation. Use Caution/Monitor.

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dantrolene

  Monitor Closely (1)dantrolene and buprenorphine both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)buprenorphine 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

  Monitor Closely (1)darunavir increases levels of buprenorphine 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.

• dasatinib

  Serious - Use Alternative (1)dasatinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• degarelix

  Serious - Use Alternative (1)degarelix and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  Monitor Closely (1)desflurane and buprenorphine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required. Serious - Use Alternative (1)desflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Monitor Closely (1)buprenorphine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (2)buprenorphine and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  deutetrabenazine and buprenorphine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  Monitor Closely (1)dexamethasone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (1)buprenorphine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and buprenorphine both increase sedation. Use Caution/Monitor.

• dextroamphetamine

  Minor (1)dextroamphetamine increases effects of buprenorphine by unspecified interaction mechanism. Minor/Significance Unknown.

• dextromoramide

  Monitor Closely (1)buprenorphine and dextromoramide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Monitor Closely (1)buprenorphine and diamorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Monitor Closely (1)diazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Serious - Use Alternative (1)diazepam intranasal, buprenorphine. 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.

• difelikefalin

  Monitor Closely (1)difelikefalin and buprenorphine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)buprenorphine and difenoxin hcl both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and buprenorphine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (1)diphenhydramine and buprenorphine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)buprenorphine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Monitor Closely (1)buprenorphine and dipipanone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Serious - Use Alternative (1)buprenorphine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

• dofetilide

  Serious - Use Alternative (1)buprenorphine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Serious - Use Alternative (1)dolasetron and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  Serious - Use Alternative (1)donepezil and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• dopexamine

  Monitor Closely (1)buprenorphine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  Monitor Closely (1)buprenorphine and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  Monitor Closely (1)buprenorphine and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)doxepin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• doxylamine

  Monitor Closely (1)doxylamine and buprenorphine both increase sedation. Use Caution/Monitor.

• dronedarone

  Contraindicated (1)buprenorphine and dronedarone both increase QTc interval. Contraindicated.

• droperidol

  Monitor Closely (1)buprenorphine and droperidol both increase sedation. Use Caution/Monitor.

• efavirenz

  Monitor Closely (1)efavirenz will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)efavirenz and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• elagolix

  Monitor Closely (1)elagolix will decrease the level or effect of buprenorphine 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.

• eliglustat

  Serious - Use Alternative (1)buprenorphine and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.

• eluxadoline

  Serious - Use Alternative (1)buprenorphine, 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. .

• elvitegravir

  Minor (1)elvitegravir increases levels of buprenorphine 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.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of buprenorphine 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.

• encorafenib

  Monitor Closely (1)encorafenib, buprenorphine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.Serious - Use Alternative (1)encorafenib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Serious - Use Alternative (1)entrectinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• enzalutamide

  Monitor Closely (1)enzalutamide will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• eribulin

  Serious - Use Alternative (1)eribulin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin base

  Serious - Use Alternative (1)buprenorphine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Serious - Use Alternative (1)buprenorphine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Serious - Use Alternative (1)buprenorphine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Serious - Use Alternative (1)buprenorphine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Serious - Use Alternative (1)buprenorphine and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, buprenorphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• estazolam

  Monitor Closely (1)estazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• ethanol

  Monitor Closely (1)buprenorphine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  Monitor Closely (1)etomidate and buprenorphine both increase sedation. Use Caution/Monitor.

• etravirine

  Monitor Closely (1)etravirine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• eucalyptus

  Minor (1)buprenorphine and eucalyptus both increase sedation. Minor/Significance Unknown.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• fenfluramine

  Monitor Closely (1)buprenorphine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  Serious - Use Alternative (2)fentanyl, buprenorphine. 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.
  
  buprenorphine 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 intranasal

  Serious - Use Alternative (2)fentanyl intranasal, buprenorphine. 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.
  
  buprenorphine 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 transdermal

  Serious - Use Alternative (2)fentanyl transdermal, buprenorphine. 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.
  
  buprenorphine 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 transmucosal

  Serious - Use Alternative (2)fentanyl transmucosal, buprenorphine. 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.
  
  buprenorphine 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.

• fexinidazole

  Serious - Use Alternative (2)fexinidazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fezolinetant

  Contraindicated (1)buprenorphine 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

• fingolimod

  Serious - Use Alternative (1)fingolimod and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• flecainide

  Serious - Use Alternative (1)buprenorphine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

• flibanserin

  Monitor Closely (1)buprenorphine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

• fluconazole

  Serious - Use Alternative (1)buprenorphine and fluconazole both increase QTc interval. Contraindicated.

• fluoxetine

  Serious - Use Alternative (1)buprenorphine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (2)buprenorphine and fluphenazine both increase QTc interval. Use Caution/Monitor.
  
  buprenorphine and fluphenazine both increase sedation. Use Caution/Monitor.

• flurazepam

  Monitor Closely (1)flurazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Serious - Use Alternative (1)buprenorphine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.

• fosamprenavir

  Monitor Closely (1)fosamprenavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .

• foscarnet

  Serious - Use Alternative (1)buprenorphine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

• fosphenytoin

  Monitor Closely (1)fosphenytoin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• fostemsavir

  Serious - Use Alternative (1)buprenorphine and fostemsavir both increase QTc interval. Avoid or Use Alternate Drug.

• gabapentin

  Monitor Closely (1)gabapentin, buprenorphine. 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

  Monitor Closely (1)gabapentin enacarbil, buprenorphine. 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

  Monitor Closely (1)buprenorphine and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Serious - Use Alternative (1)gemifloxacin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• gemtuzumab

  Serious - Use Alternative (1)buprenorphine and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  Serious - Use Alternative (1)buprenorphine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

• goserelin

  Serious - Use Alternative (1)buprenorphine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

• granisetron

  Serious - Use Alternative (1)granisetron and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• haloperidol

  Monitor Closely (1)buprenorphine and haloperidol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• histrelin

  Serious - Use Alternative (1)buprenorphine and histrelin both increase QTc interval. Avoid or Use Alternate Drug.

• hydrocodone

  Serious - Use Alternative (2)buprenorphine 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. .
  
  hydrocodone, buprenorphine. 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.

• hydromorphone

  Monitor Closely (1)buprenorphine and hydromorphone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Serious - Use Alternative (1)buprenorphine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  Monitor Closely (2)hydroxyzine and buprenorphine both increase QTc interval. Modify Therapy/Monitor Closely. If coadministration necessary, consider consider dose reduction of one or both drugs due to potential for additive pharmacological effects
  
  hydroxyzine and buprenorphine both increase sedation. Use Caution/Monitor.

• ibutilide

  Serious - Use Alternative (1)buprenorphine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of buprenorphine 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

  Monitor Closely (2)buprenorphine and iloperidone both increase sedation. Use Caution/Monitor.
  
  iloperidone increases levels of buprenorphine 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.Serious - Use Alternative (1)buprenorphine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

• imipramine

  Monitor Closely (1)buprenorphine and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.

• indinavir

  Monitor Closely (1)indinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .

• inotuzumab

  Serious - Use Alternative (1)buprenorphine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

• isocarboxazid

  Serious - Use Alternative (1)isocarboxazid increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• isoflurane

  Serious - Use Alternative (1)isoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• istradefylline

  Monitor Closely (1)istradefylline will increase the level or effect of buprenorphine 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.

• itraconazole

  Serious - Use Alternative (2)itraconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  itraconazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  Serious - Use Alternative (2)ivosidenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
  
  buprenorphine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

• ketamine

  Monitor Closely (1)ketamine and buprenorphine both increase sedation. Use Caution/Monitor.

• ketoconazole

  Serious - Use Alternative (1)ketoconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ketotifen, ophthalmic

  Monitor Closely (1)buprenorphine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lapatinib

  Serious - Use Alternative (1)buprenorphine and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

• larotrectinib

  Minor (1)larotrectinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan

  Monitor Closely (1)lasmiditan, buprenorphine. 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.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.Serious - Use Alternative (1)buprenorphine and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant

  Monitor Closely (1)lemborexant, buprenorphine. 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

  Monitor Closely (1)lenacapavir will increase the level or effect of buprenorphine 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 taking buprenorphine, consider adjusting dose for buprenorphine. Monitor clinical signs and symptoms.

• lenvatinib

  Serious - Use Alternative (1)buprenorphine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.

• letermovir

  Monitor Closely (1)letermovir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• leuprolide

  Serious - Use Alternative (1)buprenorphine and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.

• levofloxacin

  Serious - Use Alternative (1)buprenorphine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• levoketoconazole

  Serious - Use Alternative (1)levoketoconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (1)buprenorphine and levorphanol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• lidocaine

  Minor (1)lidocaine increases toxicity of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

• linezolid

  Serious - Use Alternative (1)linezolid increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• lithium

  Serious - Use Alternative (1)lithium and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• lofepramine

  Monitor Closely (1)buprenorphine and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  Monitor Closely (1)buprenorphine and lofexidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.

• lonafarnib

  Serious - Use Alternative (1)lonafarnib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

• loperamide

  Serious - Use Alternative (1)buprenorphine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

• lopinavir

  Monitor Closely (1)lopinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.Serious - Use Alternative (1)buprenorphine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

• loprazolam

  Monitor Closely (1)loprazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• lorlatinib

  Monitor Closely (1)lorlatinib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lormetazepam

  Monitor Closely (1)lormetazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)buprenorphine and loxapine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)buprenorphine and loxapine inhaled both increase sedation. Use Caution/Monitor.

• lumacaftor/ivacaftor

  Monitor Closely (1)lumacaftor/ivacaftor will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lurasidone

  Monitor Closely (1)lurasidone, buprenorphine. 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.

• macimorelin

  Serious - Use Alternative (1)buprenorphine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.

• maprotiline

  Monitor Closely (2)buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor.
  
  buprenorphine and maprotiline both increase sedation. Use Caution/Monitor.

• marijuana

  Monitor Closely (1)buprenorphine and marijuana both increase sedation. Use Caution/Monitor.

• mavacamten

  Monitor Closely (1)buprenorphine 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.

• mefloquine

  Serious - Use Alternative (1)buprenorphine and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

• melatonin

  Monitor Closely (1)buprenorphine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)buprenorphine and meperidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• meprobamate

  Monitor Closely (1)buprenorphine and meprobamate both increase sedation. Use Caution/Monitor.

• metaxalone

  Monitor Closely (1)metaxalone and buprenorphine both increase sedation. Use Caution/Monitor.

• methadone

  Monitor Closely (1)buprenorphine and methadone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)buprenorphine, 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 and methadone both increase QTc interval. Avoid or Use Alternate Drug.

• methocarbamol

  Monitor Closely (1)methocarbamol and buprenorphine both increase sedation. Use Caution/Monitor.

• methylene blue

  Serious - Use Alternative (1)methylene blue and buprenorphine both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

• methylenedioxymethamphetamine

  Monitor Closely (1)buprenorphine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metoclopramide intranasal

  Serious - Use Alternative (1)buprenorphine, 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.

• midazolam

  Monitor Closely (1)midazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, buprenorphine. 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.

• midostaurin

  Serious - Use Alternative (1)buprenorphine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

• mifepristone

  Serious - Use Alternative (2)mifepristone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  buprenorphine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.

• mirtazapine

  Monitor Closely (1)buprenorphine and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• mitotane

  Monitor Closely (1)mitotane will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• mobocertinib

  Serious - Use Alternative (1)buprenorphine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.

• morphine

  Monitor Closely (1)buprenorphine and morphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• motherwort

  Monitor Closely (1)buprenorphine and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)buprenorphine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)buprenorphine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)buprenorphine and nabilone both increase sedation. Use Caution/Monitor.

• nafcillin

  Monitor Closely (1)nafcillin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)buprenorphine and nalbuphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• nefazodone

  Serious - Use Alternative (1)nefazodone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Monitor Closely (1)nelfinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .

• nevirapine

  Monitor Closely (1)nevirapine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nilotinib

  Serious - Use Alternative (1)buprenorphine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

• nortriptyline

  Monitor Closely (1)buprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)buprenorphine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Serious - Use Alternative (1)buprenorphine and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  Monitor Closely (1)buprenorphine and olanzapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. If concurrent use of olanzapine and buprenorphine is necessary, consider dose reduction of one or both drugs.

• oliceridine

  Monitor Closely (1)oliceridine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. 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.Serious - Use Alternative (1)buprenorphine, 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

  Serious - Use Alternative (1)buprenorphine 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.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  Monitor Closely (1)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of buprenorphine 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

• ondansetron

  Serious - Use Alternative (1)buprenorphine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.

• opium tincture

  Monitor Closely (1)buprenorphine and opium tincture both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• orphenadrine

  Monitor Closely (1)orphenadrine and buprenorphine both increase sedation. Use Caution/Monitor.

• osilodrostat

  Monitor Closely (1)osilodrostat and buprenorphine both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Serious - Use Alternative (1)buprenorphine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.

• oxaliplatin

  Serious - Use Alternative (1)oxaliplatin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• oxazepam

  Monitor Closely (1)oxazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• oxcarbazepine

  Monitor Closely (1)oxcarbazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)buprenorphine and oxycodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Monitor Closely (1)buprenorphine and oxymorphone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Serious - Use Alternative (2)ozanimod and buprenorphine 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 and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.

• paliperidone

  Monitor Closely (1)buprenorphine and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

• panobinostat

  Serious - Use Alternative (1)buprenorphine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.

• papaveretum

  Monitor Closely (1)buprenorphine and papaveretum both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• papaverine

  Monitor Closely (1)buprenorphine and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)buprenorphine and paroxetine both increase QTc interval. Use Caution/Monitor.

• pasireotide

  Serious - Use Alternative (1)buprenorphine and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.

• pazopanib

  Serious - Use Alternative (1)buprenorphine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

• pegvisomant

  Monitor Closely (1)buprenorphine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

• pentamidine

  Serious - Use Alternative (1)buprenorphine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

• pentazocine

  Monitor Closely (1)buprenorphine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• pentobarbital

  Monitor Closely (2)pentobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  pentobarbital and buprenorphine both increase sedation. Use Caution/Monitor.

• perampanel

  Monitor Closely (1)perampanel and buprenorphine both increase sedation. Use Caution/Monitor.

• perphenazine

  Monitor Closely (2)buprenorphine and perphenazine both increase QTc interval. Use Caution/Monitor.
  
  buprenorphine and perphenazine both increase sedation. Use Caution/Monitor.

• phenelzine

  Serious - Use Alternative (1)phenelzine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• phenobarbital

  Monitor Closely (2)phenobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  phenobarbital and buprenorphine both increase sedation. Use Caution/Monitor.

• phenylephrine PO

  Monitor Closely (1)buprenorphine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• phenytoin

  Monitor Closely (1)phenytoin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pholcodine

  Monitor Closely (1)buprenorphine and pholcodine both increase sedation. Use Caution/Monitor.

• pimavanserin

  Serious - Use Alternative (1)buprenorphine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

• pimozide

  Monitor Closely (1)buprenorphine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and pimozide both increase QTc interval. Contraindicated.

• pitolisant

  Serious - Use Alternative (1)buprenorphine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• ponesimod

  Serious - Use Alternative (1)buprenorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

• posaconazole

  Serious - Use Alternative (2)posaconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  buprenorphine and posaconazole both increase QTc interval. Contraindicated.

• pregabalin

  Monitor Closely (1)pregabalin, buprenorphine. 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.

• primaquine

  Serious - Use Alternative (1)primaquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• primidone

  Monitor Closely (2)primidone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  primidone and buprenorphine both increase sedation. Use Caution/Monitor.

• procainamide

  Serious - Use Alternative (1)buprenorphine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

• procarbazine

  Serious - Use Alternative (1)procarbazine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Do not use within 14 days of MAOI use. .

• prochlorperazine

  Monitor Closely (2)buprenorphine and prochlorperazine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

• promethazine

  Monitor Closely (1)promethazine and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.

• propafenone

  Serious - Use Alternative (1)buprenorphine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

• propofol

  Monitor Closely (1)propofol and buprenorphine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  Monitor Closely (1)buprenorphine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  Monitor Closely (1)buprenorphine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

• quazepam

  Monitor Closely (1)quazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)buprenorphine and quetiapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.

• quinidine

  Serious - Use Alternative (1)buprenorphine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.

• quinine

  Serious - Use Alternative (1)buprenorphine and quinine both increase QTc interval. Avoid or Use Alternate Drug.

• ramelteon

  Monitor Closely (1)buprenorphine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Monitor Closely (1)buprenorphine and ranolazine both increase QTc interval. Use Caution/Monitor.

• remimazolam

  Monitor Closely (1)remimazolam, buprenorphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (1)rifampin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  Monitor Closely (1)rifapentine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  Serious - Use Alternative (1)buprenorphine and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.

• risperidone

  Monitor Closely (1)buprenorphine and risperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

• ritonavir

  Monitor Closely (1)ritonavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of buprenorphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• romidepsin

  Serious - Use Alternative (1)buprenorphine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• sage

  Minor (1)buprenorphine and sage both increase sedation. Minor/Significance Unknown.

• saquinavir

  Monitor Closely (1)saquinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .Serious - Use Alternative (1)buprenorphine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.

• scullcap

  Monitor Closely (1)buprenorphine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (2)secobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of buprenorphine
  
  secobarbital and buprenorphine both increase sedation. Use Caution/Monitor.

• selegiline

  Serious - Use Alternative (1)selegiline increases toxicity of buprenorphine 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

  Serious - Use Alternative (1)selegiline transdermal increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• selinexor

  Serious - Use Alternative (1)selinexor, buprenorphine. 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

  Serious - Use Alternative (1)buprenorphine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.

• sertraline

  Serious - Use Alternative (1)sertraline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• sevoflurane

  Monitor Closely (1)sevoflurane and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)sevoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• shepherd's purse

  Monitor Closely (1)buprenorphine and shepherd's purse both increase sedation. Use Caution/Monitor.

• siponimod

  Serious - Use Alternative (1)siponimod and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  Serious - Use Alternative (1)buprenorphine, 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.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of buprenorphine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of buprenorphine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.

• solifenacin

  Serious - Use Alternative (1)solifenacin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• sorafenib

  Serious - Use Alternative (1)buprenorphine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.

• sotalol

  Serious - Use Alternative (1)buprenorphine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

• St John's Wort

  Monitor Closely (1)St John's Wort will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  Monitor Closely (2)stiripentol, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
  
  stiripentol, buprenorphine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

• sufentanil

  Monitor Closely (1)buprenorphine and sufentanil both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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

  Serious - Use Alternative (2)buprenorphine 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.
  
  sufentanil SL, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. 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.

• sunitinib

  Serious - Use Alternative (1)sunitinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• suvorexant

  Monitor Closely (1)suvorexant and buprenorphine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tacrolimus

  Serious - Use Alternative (1)tacrolimus and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

• tapentadol

  Monitor Closely (1)buprenorphine and tapentadol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.

• tazemetostat

  Monitor Closely (1)tazemetostat will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  Monitor Closely (1)tecovirimat will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  Serious - Use Alternative (1)buprenorphine and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

• temazepam

  Monitor Closely (1)temazepam and buprenorphine both increase sedation. Use Caution/Monitor.

• tetrabenazine

  Serious - Use Alternative (1)buprenorphine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  Contraindicated (1)buprenorphine and thioridazine both increase QTc interval. Contraindicated.Monitor Closely (1)buprenorphine and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  Monitor Closely (1)buprenorphine and thiothixene both increase sedation. Use Caution/Monitor.

• tipranavir

  Monitor Closely (1)tipranavir will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)buprenorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• toremifene

  Serious - Use Alternative (1)buprenorphine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.

• tramadol

  Monitor Closely (1)buprenorphine and tramadol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)tramadol, buprenorphine. 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.
  
  buprenorphine, 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.

• tranylcypromine

  Serious - Use Alternative (1)tranylcypromine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• trazodone

  Monitor Closely (1)buprenorphine and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

• triazolam

  Monitor Closely (1)triazolam and buprenorphine both increase sedation. Use Caution/Monitor.

• triclabendazole

  Serious - Use Alternative (1)buprenorphine and triclabendazole both increase QTc interval. Avoid or Use Alternate Drug.

• triclofos

  Monitor Closely (1)triclofos and buprenorphine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (2)buprenorphine and trifluoperazine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and trifluoperazine both decrease QTc interval. Use Caution/Monitor.

• trimipramine

  Monitor Closely (1)buprenorphine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

• triprolidine

  Monitor Closely (1)triprolidine and buprenorphine both increase sedation. Use Caution/Monitor.

• triptorelin

  Serious - Use Alternative (1)buprenorphine and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.

• tucatinib

  Serious - Use Alternative (1)tucatinib will increase the level or effect of buprenorphine 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.

• valbenazine

  Monitor Closely (1)valbenazine and buprenorphine both increase QTc interval. Use Caution/Monitor.

• valerian

  Serious - Use Alternative (1)valerian and buprenorphine both increase sedation. Avoid or Use Alternate Drug.

• vandetanib

  Serious - Use Alternative (1)buprenorphine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.

• vardenafil

  Serious - Use Alternative (1)buprenorphine and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.

• vemurafenib

  Serious - Use Alternative (1)buprenorphine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

• venlafaxine

  Serious - Use Alternative (1)buprenorphine and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.

• voclosporin

  Serious - Use Alternative (1)buprenorphine and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.

• voriconazole

  Serious - Use Alternative (2)voriconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  buprenorphine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

• vorinostat

  Serious - Use Alternative (2)vorinostat and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
  
  buprenorphine and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of buprenorphine 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.

• xylometazoline

  Monitor Closely (1)buprenorphine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  Monitor Closely (1)buprenorphine and ziconotide both increase sedation. Use Caution/Monitor.Minor (1)ziconotide, buprenorphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

• ziprasidone

  Monitor Closely (1)buprenorphine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• zotepine

  Monitor Closely (1)buprenorphine and zotepine both increase sedation. Use Caution/Monitor.