Drug interactions
Buprenorphine + Butalbital
Severity: Major
Buprenorphine and Butalbital: 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
Butalbital is a barbiturate and, taken with buprenorphine, increases the risk of marked sedation, respiratory depression and overdose. Enzyme induction may also modestly reduce buprenorphine levels.
What this interaction means in plain words
Buprenorphine and Butalbital 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 depression, with possible weak CYP3A4 induction by butalbital.
What to do
Avoid concurrent use when alternatives exist; otherwise limit doses and duration and monitor for sedation and slowed breathing. Counsel patients to avoid driving and alcohol.
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 Butalbital?
MediHelp rates the interaction as major. Buprenorphine and Butalbital 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. Butalbital is a barbiturate and, taken with buprenorphine, increases the risk of marked sedation, respiratory depression and overdose. Enzyme induction may also modestly reduce buprenorphine levels.
How serious is the interaction between Buprenorphine and Butalbital?
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 concurrent use when alternatives exist; otherwise limit doses and duration and monitor for sedation and slowed breathing. Counsel patients to avoid driving and alcohol.
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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