Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)Monitor Closely (1)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 effectsondansetronSerious - Use Alternative (1)buprenorphine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.opium tinctureMonitor Closely (1)buprenorphine and opium tincture both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, opium tincture. 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.orphenadrineMonitor Closely (1)orphenadrine and buprenorphine both increase sedation. Use Caution/Monitor.osilodrostatMonitor Closely (1)osilodrostat and buprenorphine both increase QTc interval. Use Caution/Monitor.osimertinibSerious - Use Alternative (1)buprenorphine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.oxaliplatinSerious - Use Alternative (1)oxaliplatin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.oxazepamMonitor Closely (1)oxazepam and buprenorphine both increase sedation. Use Caution/Monitor.oxcarbazepineMonitor Closely (1)oxcarbazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.oxycodoneMonitor Closely (1)buprenorphine and oxycodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, oxycodone. 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.oxymorphoneMonitor Closely (1)buprenorphine and oxymorphone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, oxymorphone. 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.ozanimodSerious - Use Alternative (2)ozanimod and buprenorphine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use. buprenorphine and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.paliperidoneMonitor Closely (1)buprenorphine and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.panobinostatSerious - Use Alternative (1)buprenorphine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.papaveretumMonitor Closely (1)buprenorphine and papaveretum both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, papaveretum. 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.papaverineMonitor Closely (1)buprenorphine and papaverine both increase sedation. Use Caution/Monitor.paroxetineMonitor Closely (1)buprenorphine and paroxetine both increase QTc interval. Use Caution/Monitor.pasireotideSerious - Use Alternative (1)buprenorphine and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.pazopanibSerious - Use Alternative (1)buprenorphine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.pegvisomantMonitor Closely (1)buprenorphine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.pentamidineSerious - Use Alternative (1)buprenorphine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.pentazocineMonitor Closely (1)buprenorphine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, pentazocine. 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.pentobarbitalMonitor Closely (2)pentobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. pentobarbital and buprenorphine both increase sedation. Use Caution/Monitor.perampanelMonitor Closely (1)perampanel and buprenorphine both increase sedation. Use Caution/Monitor.perphenazineMonitor Closely (2)buprenorphine and perphenazine both increase QTc interval. Use Caution/Monitor. buprenorphine and perphenazine both increase sedation. Use Caution/Monitor.phenelzineSerious - Use Alternative (1)phenelzine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.phenobarbitalMonitor Closely (2)phenobarbital will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. phenobarbital and buprenorphine both increase sedation. Use Caution/Monitor.phenylephrine POMonitor Closely (1)buprenorphine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinMonitor Closely (1)phenytoin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodineMonitor Closely (1)buprenorphine and pholcodine both increase sedation. Use Caution/Monitor.pimavanserinSerious - Use Alternative (1)buprenorphine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.pimozideMonitor Closely (1)buprenorphine and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and pimozide both increase QTc interval. Contraindicated.pitolisantSerious - Use Alternative (1)buprenorphine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.ponesimodSerious - Use Alternative (1)buprenorphine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.posaconazoleSerious - Use Alternative (2)posaconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. buprenorphine and posaconazole both increase QTc interval. Contraindicated.pregabalinMonitor Closely (1)pregabalin, 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.primaquineSerious - Use Alternative (1)primaquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.primidoneMonitor Closely (2)primidone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. primidone and buprenorphine both increase sedation. Use Caution/Monitor.procainamideSerious - Use Alternative (1)buprenorphine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.procarbazineSerious - Use Alternative (1)procarbazine increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Do not use within 14 days of MAOI use. .prochlorperazineMonitor Closely (2)buprenorphine and prochlorperazine both increase sedation. Use Caution/Monitor. buprenorphine and prochlorperazine both decrease QTc interval. Use Caution/Monitor.promethazineMonitor Closely (1)promethazine and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.propafenoneSerious - Use Alternative (1)buprenorphine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.propofolMonitor Closely (1)propofol and buprenorphine both increase sedation. Use Caution/Monitor.propylhexedrineMonitor Closely (1)buprenorphine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (1)buprenorphine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.quazepamMonitor Closely (1)quazepam and buprenorphine both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (1)buprenorphine and quetiapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.quinidineSerious - Use Alternative (1)buprenorphine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.quinineSerious - Use Alternative (1)buprenorphine and quinine both increase QTc interval. Avoid or Use Alternate Drug.ramelteonMonitor Closely (1)buprenorphine and ramelteon both increase sedation. Use Caution/Monitor.ranolazineMonitor Closely (1)buprenorphine and ranolazine both increase QTc interval. Use Caution/Monitor.remimazolamMonitor Closely (1)remimazolam, 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.ribociclibMonitor Closely (1)ribociclib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.rifabutinMonitor Closely (1)rifabutin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinMonitor Closely (1)rifampin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifapentineMonitor Closely (1)rifapentine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rilpivirineSerious - Use Alternative (1)buprenorphine and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.risperidoneMonitor Closely (1)buprenorphine and risperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.ritonavirMonitor Closely (1)ritonavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.rolapitantMonitor Closely (1)rolapitant 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.romidepsinSerious - Use Alternative (1)buprenorphine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.rucaparibMonitor Closely (1)rucaparib 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.sageMinor (1)buprenorphine and sage both increase sedation. Minor/Significance Unknown.saquinavirMonitor Closely (1)saquinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .Serious - Use Alternative (1)buprenorphine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.scullcapMonitor Closely (1)buprenorphine and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (2)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 buprenorphine secobarbital and buprenorphine both increase sedation. Use Caution/Monitor.selegilineSerious - Use Alternative (1)selegiline increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Buprenorphine transdermal is not recommended for in patients who have received MAOI within 14 days, because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.selegiline transdermalSerious - Use Alternative (1)selegiline transdermal increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.selinexorSerious - Use Alternative (1)selinexor, buprenorphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.selpercatinibSerious - Use Alternative (1)buprenorphine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.sertralineSerious - Use Alternative (1)sertraline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.sevofluraneMonitor Closely (1)sevoflurane and buprenorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)sevoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.shepherd's purseMonitor Closely (1)buprenorphine and shepherd's purse both increase sedation. Use Caution/Monitor.siponimodSerious - Use Alternative (1)siponimod and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.sodium oxybateSerious - Use Alternative (1)buprenorphine, sodium oxybate. 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.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (1)sodium 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 sulfateMonitor Closely (1)sodium 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.solifenacinSerious - Use Alternative (1)solifenacin and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.sorafenibSerious - Use Alternative (1)buprenorphine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.sotalolSerious - Use Alternative (1)buprenorphine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.St John's WortMonitor Closely (1)St John's Wort will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.stiripentolMonitor Closely (2)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. stiripentol, 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.sufentanilMonitor Closely (1)buprenorphine and sufentanil both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, sufentanil. 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.sufentanil SLSerious - Use Alternative (2)buprenorphine decreases effects of sufentanil SL by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of opioid mixed agonist/antagonist or partial agonist may reduce sufentail SL analgesic effect and/or precipitate withdrawal symptoms. sufentanil SL, buprenorphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are