Drug interactions
Buprenorphine + Imipramine
Severity: Major
Buprenorphine and Imipramine: 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
Imipramine, a tricyclic antidepressant, can prolong the QRS and QT intervals, and buprenorphine adds a small QT effect. Sedation and serotonergic effects may also be additive.
What this interaction means in plain words
Buprenorphine and Imipramine 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; Imipramine belongs to Central Nervous System.
Why it happens
Additive QT prolongation and additive CNS depression, with a minor serotonergic contribution.
What to do
Obtain a baseline ECG and use the lowest effective imipramine dose. Monitor the QTc, electrolytes, sedation and signs of serotonin toxicity.
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
Other interactions of Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Frequently asked questions
Can I take Buprenorphine with Imipramine?
MediHelp rates the interaction as major. Buprenorphine and Imipramine 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. Imipramine, a tricyclic antidepressant, can prolong the QRS and QT intervals, and buprenorphine adds a small QT effect. Sedation and serotonergic effects may also be additive.
How serious is the interaction between Buprenorphine and Imipramine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Obtain a baseline ECG and use the lowest effective imipramine dose. Monitor the QTc, electrolytes, sedation and signs of serotonin toxicity.
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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