Drug interactions
Buprenorphine + Nalbuphine
Severity: Moderate
Buprenorphine and Nalbuphine: moderate interaction.
Last updated
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
Nalbuphine is a mixed agonist-antagonist that can partly block mu-opioid receptors, so in a patient physically dependent on or treated with buprenorphine it may reduce analgesia or precipitate withdrawal. Additive sedation and respiratory depression are also possible.
What this interaction means in plain words
Buprenorphine and Nalbuphine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Buprenorphine belongs to Musculoskeletal; Nalbuphine belongs to Musculoskeletal.
Why it happens
Competition at mu-opioid receptors between partial agonist buprenorphine and kappa-agonist/mu-antagonist nalbuphine, with additive opioid CNS effects.
What to do
Avoid using the two together; choose an analgesic strategy that does not rely on mixed agonist-antagonists. Monitor for withdrawal symptoms and respiratory depression if co-administered.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Frequently asked questions
Can I take Buprenorphine with Nalbuphine?
MediHelp rates the interaction as moderate. Buprenorphine and Nalbuphine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Nalbuphine is a mixed agonist-antagonist that can partly block mu-opioid receptors, so in a patient physically dependent on or treated with buprenorphine it may reduce analgesia or precipitate withdrawal. Additive sedation and respiratory depression are also possible.
How serious is the interaction between Buprenorphine and Nalbuphine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid using the two together; choose an analgesic strategy that does not rely on mixed agonist-antagonists. Monitor for withdrawal symptoms and respiratory depression if co-administered.
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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