Drug interactions
Buprenorphine subdermal implant + Codeine
Severity: Major
Buprenorphine subdermal implant and Codeine: 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 implants provide continuous exposure to a high-affinity partial opioid agonist. Adding codeine may blunt analgesia, precipitate withdrawal in dependent patients, or add to sedation and respiratory depression.
What this interaction means in plain words
Buprenorphine subdermal implant and Codeine 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
Competition at mu-opioid receptors by a partial agonist plus additive opioid CNS and respiratory depression.
What to do
Avoid routine co-prescribing of codeine with the implant; use non-opioid analgesia where possible. If an opioid is essential, use the lowest dose with close monitoring for respiratory depression and 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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
Frequently asked questions
Can I take Buprenorphine subdermal implant with Codeine?
MediHelp rates the interaction as major. Buprenorphine subdermal implant and Codeine 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 implants provide continuous exposure to a high-affinity partial opioid agonist. Adding codeine may blunt analgesia, precipitate withdrawal in dependent patients, or add to sedation and respiratory depression.
How serious is the interaction between Buprenorphine subdermal implant and Codeine?
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 routine co-prescribing of codeine with the implant; use non-opioid analgesia where possible. If an opioid is essential, use the lowest dose with close monitoring for respiratory depression and sedation.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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