by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.Serious - Use Alternative (1)apalutamide will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apomorphineMonitor Closely (1)buprenorphine and apomorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)apomorphine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.arformoterolMonitor Closely (1)arformoterol and buprenorphine both increase QTc interval. Use Caution/Monitor.aripiprazoleMonitor Closely (1)buprenorphine and aripiprazole both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.armodafinilMonitor Closely (1)buprenorphine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arsenic trioxideSerious - Use Alternative (1)buprenorphine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)artemether/lumefantrine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.asenapineSerious - Use Alternative (3)asenapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. buprenorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateasenapine transdermalSerious - Use Alternative (2)asenapine transdermal and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. asenapine transdermal and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateatazanavirMonitor Closely (1)atazanavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.atomoxetineSerious - Use Alternative (1)atomoxetine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.avapritinibSerious - Use Alternative (1)avapritinib and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateazelastineMonitor Closely (1)azelastine and buprenorphine both increase sedation. Use Caution/Monitor.azithromycinSerious - Use Alternative (1)buprenorphine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.baclofenMonitor Closely (1)baclofen and buprenorphine both increase sedation. Use Caution/Monitor.bedaquilineSerious - Use Alternative (1)bedaquiline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.belladonna and opiumMonitor Closely (1)buprenorphine and belladonna and opium both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, belladonna and opium. 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.belzutifanMonitor Closely (1)belzutifan will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. benperidolMonitor Closely (1)buprenorphine and benperidol both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenSerious - Use Alternative (3)benzhydrocodone/acetaminophen, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. 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. buprenorphine decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients. benzhydrocodone/acetaminophen and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebenzphetamineMonitor Closely (1)buprenorphine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.bosentanMonitor Closely (1)bosentan will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.bremelanotideSerious - Use Alternative (1)bremelanotide will decrease the level or effect of buprenorphine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.brexanoloneMonitor Closely (1)brexanolone, buprenorphine. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleSerious - Use Alternative (1)brexpiprazole and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebrimonidineSerious - Use Alternative (1)brimonidine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateMinor (1)brimonidine increases effects of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brivaracetamSerious - Use Alternative (1)brivaracetam and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebrompheniramineMonitor Closely (1)brompheniramine and buprenorphine both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantSerious - Use Alternative (1)buprenorphine subdermal implant and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (1)buprenorphine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.butabarbitalMonitor Closely (1)butabarbital and buprenorphine both increase sedation. Use Caution/Monitor.butalbitalMonitor Closely (1)butalbital and buprenorphine both increase sedation. Use Caution/Monitor.butorphanolMonitor Closely (1)buprenorphine and butorphanol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, butorphanol. 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.calcium/magnesium/potassium/sodium oxybatesSerious - Use Alternative (1)buprenorphine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. 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.carbamazepineMonitor Closely (2)carbamazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. carbamazepine decreases levels of buprenorphine by increasing metabolism. Use Caution/Monitor. Carbamazepine increases metabolism of buprenorphine; monitor for decreased efficacy.carbinoxamineMonitor Closely (1)carbinoxamine and buprenorphine both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)carisoprodol and buprenorphine both increase sedation. Use Caution/Monitor.cenobamateMonitor Closely (2)cenobamate, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor. cenobamate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.ceritinibSerious - Use Alternative (2)ceritinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. ceritinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.chloral hydrateMonitor Closely (1)chloral hydrate and buprenorphine both increase sedation. Use Caution/Monitor.chloramphenicolSerious - Use Alternative (1)chloramphenicol will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.chlordiazepoxideMonitor Closely (1)chlordiazepoxide and buprenorphine both increase sedation. Use Caution/Monitor.chloroquineSerious - Use Alternative (1)chloroquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.chlorpheniramineMonitor Closely (1)chlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)buprenorphine and chlorpromazine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.chlorzoxazoneMonitor Closely (1)chlorzoxazone and buprenorphine both increase sedation. Use Caution/Monitor.cimetidineSerious - Use Alternative (1)cimetidine increases effects of buprenorphine by decreasing metabolism. Avoid or Use Alternate Drug.cinnarizineMonitor Closely (1)cinnarizine and buprenorphine both increase sedation. Use Caution/Monitor.ciprofloxacinSerious - Use Alternative (1)buprenorphine and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.citalopramSerious - Use Alternative (1)citalopram and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinSerious - Use Alternative (2)clarithromycin will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. clarithromycin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.clemastineMonitor Closely (1)clemastine and buprenorphine both increase sedation. Use Caution/Monitor.clobazamMonitor Closely (1)buprenorphine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineMonitor Closely (1)buprenorphine and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.clonazepamMonitor Closely (1)clonazepam and buprenorphine both increase sedation. Use Caution/Monitor.clonidineSerious - Use Alternative (1)clonidine, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.clorazepateMonitor Closely (1)clorazepate and buprenorphine both increase sedation. Use Caution/Monitor.clozapineMonitor Closely (1)buprenorphine and clozapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.cobicistatMonitor Closely (1)cobicistat will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.codeineMonitor Closely (1)buprenorphine and codeine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, codeine. 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.conivaptanSerious - Use Alternative (1)conivaptan will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.crizotinibMonitor Closely (1)crizotinib increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.Serious - Use Alternative (1)crizotinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.crofelemerMonitor Closely (1)crofelemer increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.cyclizineMonitor Closely (1)cyclizine and buprenorphine both increase sedation. Use Caution/Monitor.cyclobenzaprineMonitor Closely (1)cyclobenzaprine and buprenorphine both increase sedation. Use Caution/Monitor.cyclophosphamideMinor (1)cyclophosphamide will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cyproheptadineMonitor Closely (1)cyproheptadine and buprenorphine both increase sedation. Use Caution/Monitor.dabrafenibMonitor Closely (1)dabrafenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dantroleneMonitor Closely (1)dantrolene and buprenorphine both increase sedation. Use Caution/Monitor.daridorexantMonitor Closely (1)buprenorphine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darunavirMonitor Closely (1)darunavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Carefully titrate dose when initiating buprenorphine, buprenorphine/naloxone, or methadone with patients taking darunavir/cobicstat. When initiating cobicistat in patients taking buprenorphine, buprenorphine/naloxone, or methadone, adjust dose for buprenorphine, buprenorphine/naloxone, or methadone and monitor clinical signs and symptoms.dasatinibSerious - Use Alternative (1)dasatinib and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.degarelixSerious - Use Alternative (1)degarelix and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.desfluraneMonitor Closely (1)desflurane and buprenorphine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required. Serious - Use Alternative (1)desflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.desipramineMonitor Closely (1)buprenorphine and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.deutetrabenazineMonitor Closely (2)buprenorphine and deutetrabenazine both increase sedation. Use Caution/Monitor. deutetrabenazine and buprenorphine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).dexamethasoneMonitor Closely (1)dexamethasone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dexchlorpheniramineMonitor Closely (1)dexchlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.dexfenfluramineMonitor Closely (1)buprenorphine increases and