Drug interactions
Buprenorphine + Isocarboxazid
Severity: Major
Buprenorphine and Isocarboxazid: major interaction.
Last updated Sources: UK SmPC
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 may interact with MAO inhibitors to cause serotonin syndrome or severe CNS effects including hypotension, hyperthermia, respiratory depression and coma. Buprenorphine labeling advises caution with MAOIs, and use within 14 days of an MAOI is generally avoided.
What this interaction means in plain words
Buprenorphine and Isocarboxazid 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; Isocarboxazid belongs to Central Nervous System.
Why it happens
MAO inhibition may potentiate opioid CNS effects and serotonergic or sympathetic toxicity; the exact mechanism with buprenorphine is not fully established.
What to do
Avoid buprenorphine during and for 14 days after isocarboxazid. If an opioid is essential, use closely monitored alternatives and watch for 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
- Buprenorphine 0.4 mg Sublingual tablets - SmPC sections 4.3/4.5 (class statement: MAO inhibitors; "serotonergic medicinal products, such as MAO inhibitors, selective serotonin re-uptake inhibitors (SSRIs), serotonin norepinephrine re-uptake inhibitors (SNRIs)") — electronic medicines compendium (UK SmPC)
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 Isocarboxazid
- 5-HTP + Isocarboxazid Contraindicated
- Amitriptyline + Isocarboxazid Contraindicated
- Amobarbital + Isocarboxazid Contraindicated
- Amoxapine + Isocarboxazid Contraindicated
- Apraclonidine + Isocarboxazid Contraindicated
- Atomoxetine + Isocarboxazid Contraindicated
Frequently asked questions
Can I take Buprenorphine with Isocarboxazid?
MediHelp rates the interaction as major. Buprenorphine and Isocarboxazid 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 may interact with MAO inhibitors to cause serotonin syndrome or severe CNS effects including hypotension, hyperthermia, respiratory depression and coma. Buprenorphine labeling advises caution with MAOIs, and use within 14 days of an MAOI is generally avoided.
How serious is the interaction between Buprenorphine and Isocarboxazid?
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 buprenorphine during and for 14 days after isocarboxazid. If an opioid is essential, use closely monitored alternatives and watch for 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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