Drug interactions
Buprenorphine subdermal implant + Ketoconazole
Severity: Major
Buprenorphine subdermal implant and Ketoconazole: major interaction.
Last updated Sources: UK SmPC
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
Ketoconazole strongly inhibits CYP3A4 and can increase buprenorphine concentrations. Because the implant cannot be titrated, overdose symptoms such as sedation and respiratory depression may occur.
What this interaction means in plain words
Buprenorphine subdermal implant and Ketoconazole 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
Strong CYP3A4 inhibition reduces buprenorphine N-dealkylation.
What to do
Monitor for oversedation and respiratory depression; if the inhibitor cannot be stopped, consider implant removal and switch to an adjustable buprenorphine formulation.
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
- Ketoconazole Esteve 200 mg Tablets - SmPC sections 4.3/4.5 (names the partner; "Buprenorphine IV and sublingual") — electronic medicines compendium (UK SmPC)
Other interactions of Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Frequently asked questions
Can I take Buprenorphine subdermal implant with Ketoconazole?
MediHelp rates the interaction as major. Buprenorphine subdermal implant and Ketoconazole 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. Ketoconazole strongly inhibits CYP3A4 and can increase buprenorphine concentrations. Because the implant cannot be titrated, overdose symptoms such as sedation and respiratory depression may occur.
How serious is the interaction between Buprenorphine subdermal implant and Ketoconazole?
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 for oversedation and respiratory depression; if the inhibitor cannot be stopped, consider implant removal and switch to an adjustable buprenorphine formulation.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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