Drug interactions
Buprenorphine transdermal + Codeine
Severity: Major
Buprenorphine transdermal 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
Transdermal buprenorphine gives sustained exposure to a high-affinity partial agonist. Codeine added on top can add to sedation and respiratory depression, and the partial agonism may reduce codeine analgesia or provoke withdrawal in opioid-dependent patients.
What this interaction means in plain words
Buprenorphine transdermal 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
Additive mu-opioid CNS and respiratory depression, with receptor competition by a partial agonist.
What to do
Avoid combining where alternatives exist; if used together, limit dose and duration and monitor for sedation, respiratory depression and withdrawal symptoms.
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 transdermal with Codeine?
MediHelp rates the interaction as major. Buprenorphine transdermal 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. Transdermal buprenorphine gives sustained exposure to a high-affinity partial agonist. Codeine added on top can add to sedation and respiratory depression, and the partial agonism may reduce codeine analgesia or provoke withdrawal in opioid-dependent patients.
How serious is the interaction between Buprenorphine transdermal 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 combining where alternatives exist; if used together, limit dose and duration and monitor for sedation, respiratory depression and withdrawal symptoms.
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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