Drug interactions
Buprenorphine subdermal implant + Selegiline
Severity: Major
Buprenorphine subdermal implant and Selegiline: 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
Combining an MAO inhibitor with buprenorphine may cause serotonin syndrome and, with opioids, CNS or respiratory depression. Labeling advises against use with MAOIs or within 14 days of stopping them, though selegiline at low doses is selective for MAO-B.
What this interaction means in plain words
Buprenorphine subdermal implant 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.
Why it happens
Additive serotonergic activity from MAO inhibition and opioid effects, plus additive CNS depression.
What to do
Avoid if possible, particularly with higher selegiline doses that lose MAO-B selectivity. If used, monitor for agitation, tremor, hyperthermia, clonus and respiratory depression, and remove the implant if serotonin syndrome is suspected.
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
- Eldepryl 10mg Tablets - SmPC sections 4.3/4.5 (names the partner; "Pethidine, tramadol, buprenorphine and other opioids") — electronic medicines compendium (UK SmPC)
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 subdermal implant with Selegiline?
MediHelp rates the interaction as major. Buprenorphine subdermal implant 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. Combining an MAO inhibitor with buprenorphine may cause serotonin syndrome and, with opioids, CNS or respiratory depression. Labeling advises against use with MAOIs or within 14 days of stopping them, though selegiline at low doses is selective for MAO-B.
How serious is the interaction between Buprenorphine subdermal implant 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 if possible, particularly with higher selegiline doses that lose MAO-B selectivity. If used, monitor for agitation, tremor, hyperthermia, clonus and respiratory depression, and remove the implant if serotonin syndrome is suspected.
What other medicines interact with Selegiline?
MediHelp also lists interactions of Selegiline with, for example, Amitriptyline, Amoxapine, Atomoxetine. The full list is on the Selegiline page.
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