What Are the Major Suboxone and Buprenorphine Drug Interactions?

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

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

Drugs That Cause Buprenorphine Interactions

Alcohol

Alcohol and buprenorphine/Suboxone are both central nervous system (CNS) depressants, which means that they both slow brain activity, breathing, and heart rate. 

When taken together, people may experience life-threatening respiratory depression, in which their breathing slows to a dangerous rate or stops altogether, leading to an overdose. 

And even if alcohol and Suboxone don’t interact to cause an overdose, taking them together over time can cause many issues associated with respiratory depression and hypoxia (reduced blood flow to tissues and organs). This can result in brain damage as well as damage to other organs caused by lack of oxygen.[2]

This is why doctors advise against drinking alcohol while you are taking buprenorphine.

Anticonvulsants/Nerve Pain Relievers

Researchers say some anticonvulsant drugs can kick buprenorphine off receptors and potentially make your Suboxone less effective.[3] Some examples of common seizure medications that can potentially interact with Suboxone include:[3]

• Carbamazepine
• Phenytoin
• Gabapentin

If you’re using Suboxone to resist relapse temptations, anticonvulsants could put your sobriety at risk. If you need to be on a specific anti-seizure or epileptic medication, make sure your doctor knows that you are also on Suboxone and ask about any potential interactions.

Antidepressants

Depression symptoms are common in early recovery. Your brain cells need time to heal, and while they do, they may be incapable of producing feel-good chemicals. Antidepressants can help, but some medications can reduce buprenorphine metabolism.[4]

Many patients are on both antidepressants and Suboxone together safely. It is possible and in fact very common to use both, but make sure your doctor is aware of all medications you are taking while on Suboxone, including antidepressants.

Antibiotics

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

Antifungal Medications

Some people develop fungal infections like ringworm or yeast infections that require antifungal treatment. Fungal infections can also occur commonly with needle use with persons who are injecting drugs. Some antifungals can decrease the efficacy of Suboxone. [4] If you need an antifungal agent, make sure you ask your doctor about any potential interactions with Suboxone.

Antihistamines

Most over-the-counter antihistamines, usually prescribed for allergies, are safe to use with Suboxone.[4] However, some versions of these medications, particularly diphenhydramine (Benadryl) or hydroxyzine can be sedating and, in combination with Suboxone, can make you overly sedated. Talk to your doctor about choosing antihistamine formulations that are less sedating such as Loratidine (Claritin).

Antipsychotics

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

Barbiturates

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

Benzodiazepines

People are more likely to go to the emergency room with buprenorphine-related problems when they also have benzodiazepine prescriptions.[5]

And many deaths attributed to buprenorphine are in people who were also taking benzodiazepines.[6] Of all the medications we’ve discussed so far, benzodiazepines are probably the most commonly misused in combination with Suboxone. Never mix benzodiazepines and Suboxone without first talking with your doctor.

Muscle Relaxants

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

How to Avoid Buprenorphine Interactions

The best way to avoid buprenorphine interactions and stay safe while recovering from opioid use disorder (OUD) is to talk with your doctor about all the drugs you take before you start Suboxone therapy. This includes OTC medications as well as legal substances like alcohol and nicotine. Your doctor will likely advise you not to drink alcohol while you take Suboxone because of the dangers related to sedation and overdose.

When you go to your appointment, bring your pills with you so your doctor understands your doses. Go to the same pharmacy to fill all your prescriptions, if possible, so the pharmacist can counsel you on potential interactions and contraindications. 

And remember, never take Suboxone without a prescription.

Contraindications for Buprenorphine Use

Technically, the only contraindication for Suboxone listed by the FDA is a history of hypersensitivity to buprenorphine or naloxone products, resulting in allergic reactions like anaphylaxis. People who have these types of reactions to these medications should not take them since this could be dangerous.[7]

Otherwise, no medications are listed as buprenorphine contraindications, though that doesn’t mean that serious risks don’t exist. Open and honest communication with your buprenorphine doctor about the substances you use can help keep you safe during your recovery.