Drug interactions
Benzhydrocodone / acetaminophen + Buprenorphine
Severity: Major
Benzhydrocodone / acetaminophen and Buprenorphine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Benzhydrocodone is a prodrug of hydrocodone, a full opioid agonist, and combining it with buprenorphine increases sedation and respiratory depression. Buprenorphine can also block hydrocodone's analgesic effect or precipitate withdrawal in dependent patients.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Buprenorphine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive opioid CNS and respiratory depression, with partial agonist competition at mu receptors.
What to do
Avoid the combination when possible; if unavoidable, use the lowest doses for the shortest time and monitor for respiratory depression, sedation and withdrawal.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Buprenorphine
- Alvimopan + Buprenorphine Contraindicated
- Buprenorphine + Calcium / magnesium / potassium / sodium oxybates Contraindicated
- Buprenorphine + Olanzapine / samidorphan Contraindicated
- Buprenorphine + Phenelzine Contraindicated
- Buprenorphine + Pimozide Contraindicated
- Buprenorphine + Thioridazine Contraindicated
Frequently asked questions
Can I take Benzhydrocodone / acetaminophen with Buprenorphine?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Buprenorphine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Benzhydrocodone is a prodrug of hydrocodone, a full opioid agonist, and combining it with buprenorphine increases sedation and respiratory depression. Buprenorphine can also block hydrocodone's analgesic effect or precipitate withdrawal in dependent patients.
How serious is the interaction between Benzhydrocodone / acetaminophen and Buprenorphine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination when possible; if unavoidable, use the lowest doses for the shortest time and monitor for respiratory depression, sedation and withdrawal.
What other medicines interact with Buprenorphine?
MediHelp also lists interactions of Buprenorphine with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Olanzapine / samidorphan. The full list is on the Buprenorphine page.
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