Drug interactions
Buprenorphine + Butabarbital
Severity: Major
Buprenorphine and Butabarbital: major interaction.
Last updated Sources: US FDA label
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
Barbiturates and buprenorphine both depress the CNS, so together they can cause profound sedation, respiratory depression, coma and death. Butabarbital may also lower buprenorphine exposure through enzyme induction.
What this interaction means in plain words
Buprenorphine and Butabarbital 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 CNS and respiratory depression, plus possible CYP3A4 induction by the barbiturate that lowers buprenorphine concentrations.
What to do
Avoid the combination where possible; if it is necessary, use the lowest effective doses for the shortest duration and monitor sedation and respiratory rate. Watch for reduced opioid effect or 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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References
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 Buprenorphine with Butabarbital?
MediHelp rates the interaction as major. Buprenorphine and Butabarbital 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. Barbiturates and buprenorphine both depress the CNS, so together they can cause profound sedation, respiratory depression, coma and death. Butabarbital may also lower buprenorphine exposure through enzyme induction.
How serious is the interaction between Buprenorphine and Butabarbital?
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 where possible; if it is necessary, use the lowest effective doses for the shortest duration and monitor sedation and respiratory rate. Watch for reduced opioid effect or 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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