buprenorphine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.maprotilinebuprenorphine and maprotiline both increase sedation. Use Caution/Monitor.buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor.marijuanabuprenorphine and marijuana both increase sedation. Use Caution/Monitor.mavacamtenbuprenorphine will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose. melatoninbuprenorphine and melatonin both increase sedation. Use Caution/Monitor.meperidinebuprenorphine and meperidine both increase sedation. Use Caution/Monitor.meprobamatebuprenorphine and meprobamate both increase sedation. Use Caution/Monitor.metaxalonemetaxalone and buprenorphine both increase sedation. Use Caution/Monitor.methadonebuprenorphine and methadone both increase sedation. Use Caution/Monitor.methocarbamolmethocarbamol and buprenorphine both increase sedation. Use Caution/Monitor.methylenedioxymethamphetaminebuprenorphine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.midazolammidazolam and buprenorphine both increase sedation. Use Caution/Monitor.midazolam intranasalmidazolam intranasal, buprenorphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.mirtazapinebuprenorphine and mirtazapine both increase sedation. Use Caution/Monitor.mitotanemitotane will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.morphinebuprenorphine and morphine both increase sedation. Use Caution/Monitor.motherwortbuprenorphine and motherwort both increase sedation. Use Caution/Monitor.moxonidinebuprenorphine and moxonidine both increase sedation. Use Caution/Monitor.nabilonebuprenorphine and nabilone both increase sedation. Use Caution/Monitor.nafcillinnafcillin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nalbuphinebuprenorphine and nalbuphine both increase sedation. Use Caution/Monitor.nelfinavirnelfinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .nevirapinenevirapine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nortriptylinebuprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.olanzapinebuprenorphine and olanzapine both increase sedation. Use Caution/Monitor.oliceridineoliceridine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increases levels of buprenorphine and active metabolite norbuprenorphine; no dose adjustment of buprenorphine is required, but closely monitor for sedation and cognitive effectsopium tincturebuprenorphine and opium tincture both increase sedation. Use Caution/Monitor.orphenadrineorphenadrine and buprenorphine both increase sedation. Use Caution/Monitor.osilodrostatosilodrostat and buprenorphine both increase QTc interval. Use Caution/Monitor.oxazepamoxazepam and buprenorphine both increase sedation. Use Caution/Monitor.oxcarbazepineoxcarbazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.oxycodonebuprenorphine and oxycodone both increase sedation. Use Caution/Monitor.oxymorphonebuprenorphine and oxymorphone both increase sedation. Use Caution/Monitor.paliperidonebuprenorphine and paliperidone both increase sedation. Use Caution/Monitor.papaveretumbuprenorphine and papaveretum both increase sedation. Use Caution/Monitor.papaverinebuprenorphine and papaverine both increase sedation. Use Caution/Monitor.paroxetinebuprenorphine and paroxetine both increase QTc interval. Use Caution/Monitor.pegvisomantbuprenorphine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.pentazocinebuprenorphine and pentazocine both increase sedation. Use Caution/Monitor.pentobarbitalpentobarbital and buprenorphine both increase sedation. Use Caution/Monitor.pentobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.perampanelperampanel and buprenorphine both increase sedation. Use Caution/Monitor.perphenazinebuprenorphine and perphenazine both increase sedation. Use Caution/Monitor.buprenorphine and perphenazine both increase QTc interval. Use Caution/Monitor.phenobarbitalphenobarbital and buprenorphine both increase sedation. Use Caution/Monitor.phenobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.phenylephrine PObuprenorphine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinphenytoin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodinebuprenorphine and pholcodine both increase sedation. Use Caution/Monitor.pimozidebuprenorphine and pimozide both increase sedation. Use Caution/Monitor.pregabalinpregabalin, buprenorphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneprimidone and buprenorphine both increase sedation. Use Caution/Monitor.primidone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.prochlorperazinebuprenorphine and prochlorperazine both increase sedation. Use Caution/Monitor.buprenorphine and prochlorperazine both decrease QTc interval. Use Caution/Monitor.promethazinepromethazine and buprenorphine both increase sedation. Use Caution/Monitor.propofolpropofol and buprenorphine both increase sedation. Use Caution/Monitor.propylhexedrinebuprenorphine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylinebuprenorphine and protriptyline both increase sedation. Use Caution/Monitor.quazepamquazepam and buprenorphine both increase sedation. Use Caution/Monitor.quetiapinebuprenorphine and quetiapine both increase sedation. Use Caution/Monitor.ramelteonbuprenorphine and ramelteon both increase sedation. Use Caution/Monitor.ranolazinebuprenorphine and ranolazine both increase QTc interval. Use Caution/Monitor.remimazolamremimazolam, buprenorphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.ribociclibribociclib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinrifabutin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinrifampin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifapentinerifapentine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidonebuprenorphine and risperidone both increase sedation. Use Caution/Monitor.ritonavirritonavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.rolapitantrolapitant will increase the level or effect of buprenorphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.rucaparibrucaparib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.saquinavirsaquinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .scullcapbuprenorphine and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital and buprenorphine both increase sedation. Use Caution/Monitor.secobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of buprenorphinesevofluranesevoflurane and buprenorphine both increase sedation. Use Caution/Monitor.shepherd's pursebuprenorphine and shepherd's purse both increase sedation. Use Caution/Monitor.sodium sulfate/?magnesium sulfate/potassium chloridesodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of buprenorphine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.sodium sulfate/potassium sulfate/magnesium sulfatesodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of buprenorphine by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.St John's WortSt John's Wort will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.stiripentolstiripentol, buprenorphine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.stiripentol, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.sufentanilbuprenorphine and sufentanil both increase sedation. Use Caution/Monitor.suvorexantsuvorexant and buprenorphine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytapentadolbuprenorphine and tapentadol both increase sedation. Use Caution/Monitor.tazemetostattazemetostat will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimattecovirimat will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.temazepamtemazepam and buprenorphine both increase sedation. Use Caution/Monitor.thioridazinebuprenorphine and thioridazine both increase sedation. Use Caution/Monitor.thiothixenebuprenorphine and thiothixene both increase sedation. Use Caution/Monitor.tipranavirtipranavir will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.topiramatebuprenorphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolbuprenorphine and tramadol both increase sedation. Use Caution/Monitor.trazodonebuprenorphine and trazodone both increase sedation. Use Caution/Monitor.triazolamtriazolam and buprenorphine both increase sedation. Use Caution/Monitor.triclofostriclofos and buprenorphine both increase sedation. Use Caution/Monitor.trifluoperazinebuprenorphine and trifluoperazine both increase sedation. Use Caution/Monitor.buprenorphine and trifluoperazine both decrease QTc interval. Use Caution/Monitor.trimipraminebuprenorphine and trimipramine both increase sedation. Use Caution/Monitor.triprolidinetriprolidine and buprenorphine both increase sedation. Use Caution/Monitor.valbenazinevalbenazine and buprenorphine both increase QTc interval. Use Caution/Monitor.xylometazolinebuprenorphine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotidebuprenorphine and ziconotide both increase sedation. Use Caution/Monitor.ziprasidonebuprenorphine and ziprasidone both increase sedation. Use Caution/Monitor.zotepinebuprenorphine and zotepine both increase sedation. Use Caution/Monitor.Minor (11)acetazolamideacetazolamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.anastrozoleanastrozole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.brimonidinebrimonidine increases effects of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.cyclophosphamidecyclophosphamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dextroamphetaminedextroamphetamine increases effects of buprenorphine by unspecified interaction mechanism. Minor/Significance Unknown.elvitegravirelvitegravir increases levels of buprenorphine by unknown mechanism. Minor/Significance Unknown. No dose adjustment of buprenorphine/naloxone is required upon coadministration with VITEKTA. Patients should be closely monitored for sedation and cognitive effects.elvitegravir decreases levels of naloxone by unknown mechanism. Minor/Significance Unknown. No dose adjustment of buprenorphine/naloxone is required upon coadministration with VITEKTA. Patients should be closely monitored for sedation and cognitive effects.eucalyptusbuprenorphine and eucalyptus both increase sedation. Minor/Significance Unknown.larotrectiniblarotrectinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.lidocainelidocaine increases toxicity of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.sagebuprenorphine and sage both increase sedation. Minor/Significance Unknown.ziconotideziconotide, buprenorphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.abametapirSerious - Use Alternative (1)abametapir will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concomitant use is warranted, carefully monitor, particularly during treatment initiation and dose adjustment. Discontinue oliceridine if serotonin syndrome is suspected.acetazolamideMinor (1)acetazolamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.acrivastineSerious - Use Alternative (1)acrivastine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatealbuterolMonitor Closely (2)buprenorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and buprenorphine both increase QTc interval. Use Caution/Monitor.alfentanilMonitor Closely (1)alfentanil and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.alfuzosinSerious - Use Alternative (1)alfuzosin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.alprazolamMonitor Closely (1)alprazolam and buprenorphine both increase sedation. Use Caution/Monitor.alvimopanContraindicated (1)alvimopan, buprenorphine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.amiodaroneSerious - Use Alternative (1)buprenorphine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideSerious - Use Alternative (2)amisulpride and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered. amisulpride and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateamitriptylineMonitor Closely (1)buprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.amobarbitalMonitor Closely (2)amobarbital and buprenorphine both increase sedation. Use Caution/Monitor. amobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amoxapineMonitor Closely (1)buprenorphine and amoxapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.anagrelideSerious - Use Alternative (2)anagrelide and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. buprenorphine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.anastrozoleMinor (1)anastrozole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.apalutamideMonitor Closely (1)apalutamide will decrease the level or effect of buprenorphine