Drug interactions
Buprenorphine + Selegiline
Severity: Major
Buprenorphine and Selegiline: 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
Opioids given with MAO inhibitors have caused severe, unpredictable reactions including serotonin toxicity, hypotension, and respiratory depression or coma. Buprenorphine labeling advises against use within 14 days of an MAOI. Selegiline is selective for MAO-B at low oral doses but loses selectivity at higher doses and with the transdermal form.
What this interaction means in plain words
Buprenorphine and Selegiline 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; Selegiline belongs to Central Nervous System.
Why it happens
Possible serotonergic and CNS-depressant potentiation by MAO inhibition; the exact mechanism with buprenorphine is not well established.
What to do
Avoid concurrent use and for 14 days after stopping the MAOI where feasible; if unavoidable, use the lowest buprenorphine dose with close monitoring for serotonin syndrome, blood pressure and respiratory depression.
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 Selegiline
- Amitriptyline + Selegiline Contraindicated
- Amoxapine + Selegiline Contraindicated
- Atomoxetine + Selegiline Contraindicated
- Benzphetamine + Selegiline Contraindicated
- Brimonidine + Selegiline Contraindicated
- Buprenorphine long-acting + Selegiline Contraindicated
Frequently asked questions
Can I take Buprenorphine with Selegiline?
MediHelp rates the interaction as major. Buprenorphine and Selegiline 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. Opioids given with MAO inhibitors have caused severe, unpredictable reactions including serotonin toxicity, hypotension, and respiratory depression or coma. Buprenorphine labeling advises against use within 14 days of an MAOI. Selegiline is selective for MAO-B at low oral doses but loses selectivity at higher doses and with the transdermal form.
How serious is the interaction between Buprenorphine and Selegiline?
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 and for 14 days after stopping the MAOI where feasible; if unavoidable, use the lowest buprenorphine dose with close monitoring for serotonin syndrome, blood pressure and respiratory depression.
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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