Drug interactions
Buprenorphine + Codeine
Severity: Major
Buprenorphine and Codeine: 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
Buprenorphine is a high-affinity partial mu agonist that can displace codeine's active metabolite from receptors. In opioid-dependent patients this may precipitate withdrawal, while in others it blunts codeine analgesia and adds to sedation and respiratory depression.
What this interaction means in plain words
Buprenorphine and Codeine 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.
Buprenorphine belongs to Musculoskeletal; Codeine belongs to Musculoskeletal.
Why it happens
Competitive binding at mu-opioid receptors by a high-affinity partial agonist, with additive CNS depression.
What to do
Avoid combining where possible and use a single opioid strategy. If combined, monitor for withdrawal, inadequate analgesia and respiratory depression.
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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
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 Codeine?
MediHelp rates the interaction as major. Buprenorphine and Codeine 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. Buprenorphine is a high-affinity partial mu agonist that can displace codeine's active metabolite from receptors. In opioid-dependent patients this may precipitate withdrawal, while in others it blunts codeine analgesia and adds to sedation and respiratory depression.
How serious is the interaction between Buprenorphine and Codeine?
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 combining where possible and use a single opioid strategy. If combined, monitor for withdrawal, inadequate analgesia and respiratory depression.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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