Drug interactions
Buprenorphine + Primidone
Severity: Major
Buprenorphine and Primidone: 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
Primidone, which is partly metabolized to phenobarbital, adds CNS depression to buprenorphine. It also induces CYP3A4 and may reduce buprenorphine concentrations, risking withdrawal or reduced analgesia.
What this interaction means in plain words
Buprenorphine and Primidone 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; Primidone belongs to Central Nervous System.
Why it happens
Additive CNS depression plus CYP3A4 induction by primidone and its phenobarbital metabolite.
What to do
Monitor sedation, respiration and withdrawal symptoms, and adjust buprenorphine to clinical response. Reassess dosing if primidone is started, changed or stopped.
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 Primidone
- Lorlatinib + Primidone Contraindicated
- Lurasidone + Primidone Contraindicated
- Primidone + Ranolazine Contraindicated
- Primidone + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
- Primidone + Voriconazole Contraindicated
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Buprenorphine with Primidone?
MediHelp rates the interaction as major. Buprenorphine and Primidone 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. Primidone, which is partly metabolized to phenobarbital, adds CNS depression to buprenorphine. It also induces CYP3A4 and may reduce buprenorphine concentrations, risking withdrawal or reduced analgesia.
How serious is the interaction between Buprenorphine and Primidone?
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 sedation, respiration and withdrawal symptoms, and adjust buprenorphine to clinical response. Reassess dosing if primidone is started, changed or stopped.
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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