Drug interactions
Buprenorphine + Diamorphine
Severity: Major
Buprenorphine and Diamorphine: 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 has high receptor affinity and can displace diamorphine (heroin), precipitating withdrawal in dependent patients or blunting analgesia. When both are active, additive sedation and respiratory depression can occur.
What this interaction means in plain words
Buprenorphine and Diamorphine 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
Partial agonist competition at mu-opioid receptors, with additive respiratory depression.
What to do
Start buprenorphine only after objective signs of mild withdrawal appear, to avoid precipitated withdrawal. Monitor for respiratory depression if both are used.
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 Diamorphine?
MediHelp rates the interaction as major. Buprenorphine and Diamorphine 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 has high receptor affinity and can displace diamorphine (heroin), precipitating withdrawal in dependent patients or blunting analgesia. When both are active, additive sedation and respiratory depression can occur.
How serious is the interaction between Buprenorphine and Diamorphine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start buprenorphine only after objective signs of mild withdrawal appear, to avoid precipitated withdrawal. Monitor for respiratory depression if both are used.
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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