Drug interactions
Buprenorphine + Levorphanol
Severity: Major
Buprenorphine and Levorphanol: 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
Buprenorphine is a high-affinity partial mu-opioid agonist and can displace a full agonist such as levorphanol from the receptor. In patients physically dependent on full agonists this may precipitate withdrawal, while in others the combination adds to sedation and respiratory depression. The net effect is unpredictable.
What this interaction means in plain words
Buprenorphine and Levorphanol 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
Competitive receptor binding by a partial agonist with high affinity against a full mu-agonist, plus additive CNS and respiratory depression.
What to do
Avoid combining them where possible and choose a single opioid strategy. If a switch is needed, plan the transition with attention to withdrawal signs and sedation.
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 Levorphanol?
MediHelp rates the interaction as major. Buprenorphine and Levorphanol 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 is a high-affinity partial mu-opioid agonist and can displace a full agonist such as levorphanol from the receptor. In patients physically dependent on full agonists this may precipitate withdrawal, while in others the combination adds to sedation and respiratory depression. The net effect is unpredictable.
How serious is the interaction between Buprenorphine and Levorphanol?
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 combining them where possible and choose a single opioid strategy. If a switch is needed, plan the transition with attention to withdrawal signs and sedation.
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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