Drug interactions
Buprenorphine + Itraconazole
Severity: Major
Buprenorphine and Itraconazole: 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
Itraconazole strongly inhibits CYP3A4, the main enzyme metabolizing buprenorphine, which can raise buprenorphine levels and cause excess sedation and respiratory depression. Both drugs also have QT-prolonging potential.
What this interaction means in plain words
Buprenorphine and Itraconazole 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; Itraconazole belongs to Anti Fungals.
Why it happens
CYP3A4 inhibition reduces buprenorphine clearance, combined with additive QT prolongation.
What to do
Monitor for sedation, respiratory depression and opioid toxicity, and reduce the buprenorphine dose if needed. Check an ECG if there are other QT risk factors.
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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
Frequently asked questions
Can I take Buprenorphine with Itraconazole?
MediHelp rates the interaction as major. Buprenorphine and Itraconazole 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. Itraconazole strongly inhibits CYP3A4, the main enzyme metabolizing buprenorphine, which can raise buprenorphine levels and cause excess sedation and respiratory depression. Both drugs also have QT-prolonging potential.
How serious is the interaction between Buprenorphine and Itraconazole?
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 for sedation, respiratory depression and opioid toxicity, and reduce the buprenorphine dose if needed. Check an ECG if there are other QT risk factors.
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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