Drug interactions
Buprenorphine + Erythromycin ethylsuccinate
Severity: Major
Buprenorphine and Erythromycin ethylsuccinate: 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
Erythromycin prolongs the QT interval and strongly inhibits CYP3A4, the main enzyme metabolizing buprenorphine. This can raise buprenorphine exposure, causing excess sedation or respiratory depression, in addition to additive QT effects.
What this interaction means in plain words
Buprenorphine and Erythromycin ethylsuccinate 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
CYP3A4 inhibition raises buprenorphine levels, combined with additive QTc prolongation.
What to do
Prefer a non-macrolide antibiotic such as one without CYP3A4 inhibition or QT effects. If used together, monitor for sedation, respiratory depression and QTc, and consider reducing the buprenorphine dose.
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 Erythromycin ethylsuccinate?
MediHelp rates the interaction as major. Buprenorphine and Erythromycin ethylsuccinate 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. Erythromycin prolongs the QT interval and strongly inhibits CYP3A4, the main enzyme metabolizing buprenorphine. This can raise buprenorphine exposure, causing excess sedation or respiratory depression, in addition to additive QT effects.
How serious is the interaction between Buprenorphine and Erythromycin ethylsuccinate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer a non-macrolide antibiotic such as one without CYP3A4 inhibition or QT effects. If used together, monitor for sedation, respiratory depression and QTc, and consider reducing the buprenorphine dose.
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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