Drug interactions
Buprenorphine + Methadone
Severity: Major
Buprenorphine and Methadone: 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 partial mu-opioid agonist with high receptor affinity and can displace methadone, precipitating withdrawal in methadone-dependent patients. Both also prolong the QT interval and cause additive respiratory and CNS depression.
What this interaction means in plain words
Buprenorphine and Methadone 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; Methadone belongs to Musculoskeletal.
Why it happens
Competitive receptor binding by a high-affinity partial agonist displaces a full agonist, with additive QT prolongation and CNS depression.
What to do
Avoid concurrent use unless performing a planned transition from methadone to buprenorphine under specialist supervision, ideally at a low methadone dose and with mild withdrawal present. Monitor the ECG and for 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 Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
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 Methadone?
MediHelp rates the interaction as major. Buprenorphine and Methadone 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 partial mu-opioid agonist with high receptor affinity and can displace methadone, precipitating withdrawal in methadone-dependent patients. Both also prolong the QT interval and cause additive respiratory and CNS depression.
How serious is the interaction between Buprenorphine and Methadone?
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 concurrent use unless performing a planned transition from methadone to buprenorphine under specialist supervision, ideally at a low methadone dose and with mild withdrawal present. Monitor the ECG and for sedation.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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