Drug interactions
Buprenorphine long-acting + Methadone
Severity: Major
Buprenorphine long-acting 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
Long-acting injectable buprenorphine can precipitate withdrawal in patients dependent on methadone and cannot be removed once given. Both drugs prolong QT and add to sedation.
What this interaction means in plain words
Buprenorphine long-acting 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.
Why it happens
Partial agonist displacement at mu receptors with additive QT prolongation and CNS depression.
What to do
Transition from methadone only under specialist supervision and after stabilization on a lower methadone dose and a transmucosal buprenorphine trial. Monitor for withdrawal, sedation and QTc.
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
Frequently asked questions
Can I take Buprenorphine long-acting with Methadone?
MediHelp rates the interaction as major. Buprenorphine long-acting 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. Long-acting injectable buprenorphine can precipitate withdrawal in patients dependent on methadone and cannot be removed once given. Both drugs prolong QT and add to sedation.
How serious is the interaction between Buprenorphine long-acting 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: Transition from methadone only under specialist supervision and after stabilization on a lower methadone dose and a transmucosal buprenorphine trial. Monitor for withdrawal, sedation and QTc.
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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