Drug interactions
Buprenorphine transdermal + Hydromorphone
Severity: Major
Buprenorphine transdermal and Hydromorphone: 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 maintains steady mu-receptor occupancy, so hydromorphone may be less effective and withdrawal may occur in dependent patients. Sedation and respiratory depression can also be additive.
What this interaction means in plain words
Buprenorphine transdermal and Hydromorphone 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 buprenorphine competes for mu receptors with hydromorphone, plus additive opioid CNS depression.
What to do
Avoid combining unless justified, and then use the lowest effective doses with monitoring for sedation, respiratory depression, withdrawal and uncontrolled pain. Consider optimizing a single opioid.
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 Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Buprenorphine transdermal with Hydromorphone?
MediHelp rates the interaction as major. Buprenorphine transdermal and Hydromorphone 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 maintains steady mu-receptor occupancy, so hydromorphone may be less effective and withdrawal may occur in dependent patients. Sedation and respiratory depression can also be additive.
How serious is the interaction between Buprenorphine transdermal and Hydromorphone?
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 unless justified, and then use the lowest effective doses with monitoring for sedation, respiratory depression, withdrawal and uncontrolled pain. Consider optimizing a single opioid.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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