Does Suboxone Have Interactions With Other Prescriptions or Medications I Might Be Taking?

Some prescription and over-the-counter medications interact with Suboxone and cause reactions, usually medications that are sedating.

These are a few of the medications that might interact with Suboxone:

• Antibiotics 
• Antidepressants
• Antifungals
• Antihistamines
• Benzodiazepines
• Gabapentinoids 
• Other opioid medications
• Protease inhibitors 
• Rifampin
• Seizure medications 
• St. John’s wort

Medications That May Interact With Suboxone 

Some medications keep Suboxone from breaking down inside your body, or they work very similarly to Suboxone. Combining these drugs with Suboxone could make you feel overly sedated.

These are a few drugs known to cause this problem. 

Antibiotics

Many antibiotics like clarithromycin and erythromycin can cause your liver to process other drugs more quickly or slowly, which could change your body’s processing of buprenorphine.[1] If you need to be on an antibiotic, talk to your doctor about whether you might need a Suboxone dose adjustment while on that antibiotic. 

Antidepressants

Most common antidepressants are non-sedating, and many people are safely on both antidepressants and Suboxone simultaneously. However, some antidepressant medications can be sedating and cause you to become oversedated with Suboxone.[2]

If you are on an antidepressant before starting Suboxone or are on Suboxone and want to start an antidepressant, let your doctor know so they can counsel you about any potential risks or side effects.

Antihistamines

Antihistamine drugs are usually allergy medications such as Zyrtec, cetirizine, hydroxyzine, and diphenhydramine (Benadryl). These medications are often over the counter, but they can be sedating and cause oversedation if combined with Suboxone. Tell your doctor if you are using these medications while on Suboxone.

Benzodiazepines

Klonopin, Xanax, Valium, and other benzodiazepines are central nervous system depressants. Most people take them as anti-anxiety medications. Mixing benzos with the buprenorphine in Suboxone can be dangerous because both drug classes can cause sedation, leading to respiratory depression and fatal overdose.[3]

Benzodiazepines can also cause euphoria, and some people who use them become addicted. Using multiple potentially addictive or habit-forming medications can be dangerous.

Gabapentinoids

Gabapentinoids are pain medications used particularly for neuropathic (nerve-related) pain. Their common names are gabapentin (Neurontin) or pregabalin (Lyrica).

These medications can also be sedating, increasing the risk of respiratory depression if taken with Suboxone. Many people take Suboxone and gabapentinoids together, but this should be done under careful medical supervision.

Other Opioid Medications

Patients on Suboxone may occasionally need to take opioid pain medications in addition to their Suboxone if they have an acute injury or surgery. This can be done safely while still on Suboxone.

If you are injured or anticipating an upcoming surgery where you might need pain relief postoperatively, talk to your doctor about whether or not you should continue or temporarily discontinue your Suboxone dose and which pain medications will be safe for you to use as you recover.

Protease Inhibitors

Protease inhibitors are a class of HIV medications. These days, protease inhibitors are less common HIV meds, and your doctor will usually not start you on them.

However, if you are on a protease-inhibitor-based HIV medication, let your doctor know so they can properly adjust your Suboxone dose or potentially change your HIV regimen if necessary. Some formulations increase your buprenorphine levels, making you feel sedated.[4]

Seizure Medications

Anti-seizure drugs like Depakote, topiramate, and Keppra are CNS depressants that can be sedating when combined with Suboxone. Let your doctor know if you are on any of these medications while also taking Suboxone.

Antifungals

Antifungal medications like fluconazole and ketoconazole can help treat fungus. Some antifungals affect liver function and can cause buprenorphine levels to increase or decrease.[5] If you need to take an antifungal while on Suboxone, talk to your doctor before starting.

John’s Wort

St John’s wort is a dietary supplement many people use to treat symptoms of depression. Several over-the-counter medications, including St. John’s wort, can cause your body to over- or under-process other medications in your liver, including Suboxone. Check with your doctor before taking any supplement while on Suboxone, including St John’s wort.

Rifampin

This tuberculosis medication can reduce your body’s ability to process multiple medications, including buprenorphine. Rifampin can result in either underdosing or overdosing Suboxone. Rifampin could push you into buprenorphine withdrawal, which can feel like a sudden and persistent case of the flu.[6] If you need to take Rifampin for tuberculosis treatment, make sure you talk to your doctor about potentially adjusting your Suboxone dose accordingly.

Why Can’t You Mix Some Medications With Suboxone?

Buprenorphine/naloxone (Suboxone) does not interact adversely with most medications. However, because Suboxone can cause some sedation, particularly at first, taking it with other sedating drugs is NOT advisable.

Avoid these sedating drugs while you are taking Suboxone:

• Benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan)
• Muscle relaxers
• Tranquilizers
• Sleeping agents
• Alcohol

Taking too many sedating medications can lead to respiratory depression and even overdose.

If you are taking multiple sedating medications, your doctor should monitor you closely. Make sure you report feeling overly tired or sedated while on these medications so your dose can be adjusted properly. 

What to Do if You Took a Medication on This List While on Suboxone

If you recognize one of these medications as something you took or take currently while on Suboxone, don’t panic. Talk with your doctor. They can advise you on the best path forward.

Sources

1. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed July 2022.
2. Medication Guide: Suboxone. U.S. Food and Drug Administration. https://online.lexi.com/lco/medguides/633198.pdf. February 2017. Accessed July 2022.
3. Benzodiazepine Use During Buprenorphine Treatment for Opioid Dependence: Clinical and Safety Outcomes. Drug and Alcohol Dependence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916951/. October 2014. Accessed July 2022.
4. Interaction Between Buprenorphine and Atazanavir or Atazanavir/Ritonavir. Drug and Alcohol Dependence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272856/. February 2012. Accessed July 2022.
5. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed July 2022. 
6. Rifampin But Not Rifabutin May Produce Opiate Withdrawal in Buprenorphine-Maintained Patients. Drug and Alcohol Dependence. https://www.sciencedirect.com/science/article/abs/pii/S0376871611001700. November 2011. Accessed July 2022.