Drug interactions
Buprenorphine + Esketamine
Severity: Major
Buprenorphine and Esketamine: major interaction.
Last updated
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
Opioids and esketamine both depress the CNS, and together they raise the risk of profound sedation and respiratory depression. Buprenorphine has a ceiling on respiratory effects, but the risk remains when combined with other depressants.
What this interaction means in plain words
Buprenorphine and Esketamine 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; Esketamine belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression via opioid receptor agonism and NMDA antagonism.
What to do
Monitor sedation, respiratory rate and oxygen saturation closely during and after esketamine administration, and use the lowest effective 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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Other interactions of Esketamine
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 Esketamine?
MediHelp rates the interaction as major. Buprenorphine and Esketamine 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. Opioids and esketamine both depress the CNS, and together they raise the risk of profound sedation and respiratory depression. Buprenorphine has a ceiling on respiratory effects, but the risk remains when combined with other depressants.
How serious is the interaction between Buprenorphine and Esketamine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sedation, respiratory rate and oxygen saturation closely during and after esketamine administration, and use the lowest effective buprenorphine dose.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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