Avoid or Use Alternate Drug.buprenorphine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.mirtazapinemirtazapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.mobocertinibbuprenorphine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.morphinebuprenorphine, morphine. 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.moxifloxacinbuprenorphine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.nalbuphinebuprenorphine, nalbuphine. 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.naldemedinenaldemedine, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive opioid receptor anatagonism and increased risk of opioid withdrawal.naloxegolnaloxegol, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration; potential for additive effect of opioid receptor anatagonism and increased risk of opioid withdrawal.nefazodonenefazodone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Monitor Closely (217)albuterolbuprenorphine 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.alfentanilalfentanil and buprenorphine both increase sedation. Use Caution/Monitor.alprazolamalprazolam and buprenorphine both increase sedation. Use Caution/Monitor.amitriptylinebuprenorphine and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalamobarbital 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.amoxapinebuprenorphine and amoxapine both increase sedation. Use Caution/Monitor.apalutamideapalutamide will decrease the level or effect of buprenorphine by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.apomorphinebuprenorphine and apomorphine both increase sedation. Use Caution/Monitor.arformoterolarformoterol and buprenorphine both increase QTc interval. Use Caution/Monitor.aripiprazolebuprenorphine and aripiprazole both increase sedation. Use Caution/Monitor.armodafinilbuprenorphine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.atazanaviratazanavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.azelastineazelastine and buprenorphine both increase sedation. Use Caution/Monitor.baclofenbaclofen and buprenorphine both increase sedation. Use Caution/Monitor.belladonna and opiumbuprenorphine and belladonna and opium both increase sedation. Use Caution/Monitor.belzutifanbelzutifan 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. benperidolbuprenorphine and benperidol both increase sedation. Use Caution/Monitor.benzphetaminebuprenorphine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.bosentanbosentan will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.brexanolonebrexanolone, buprenorphine. Either increases toxicity of the other by sedation. Use Caution/Monitor.brompheniraminebrompheniramine and buprenorphine both increase sedation. Use Caution/Monitor.buprenorphine, long-acting injectionbuprenorphine 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.butabarbitalbutabarbital and buprenorphine both increase sedation. Use Caution/Monitor.butalbitalbutalbital and buprenorphine both increase sedation. Use Caution/Monitor.butorphanolbuprenorphine and butorphanol both increase sedation. Use Caution/Monitor.carbamazepinecarbamazepine decreases levels of buprenorphine by increasing metabolism. Use Caution/Monitor. Carbamazepine increases metabolism of buprenorphine; monitor for decreased efficacy.carbamazepine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbinoxaminecarbinoxamine and buprenorphine both increase sedation. Use Caution/Monitor.carisoprodolcarisoprodol and buprenorphine both increase sedation. Use Caution/Monitor.cenobamatecenobamate 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.cenobamate, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor.chloral hydratechloral hydrate and buprenorphine both increase sedation. Use Caution/Monitor.chlordiazepoxidechlordiazepoxide and buprenorphine both increase sedation. Use Caution/Monitor.chlorpheniraminechlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.chlorpromazinebuprenorphine and chlorpromazine both increase sedation. Use Caution/Monitor.chlorzoxazonechlorzoxazone and buprenorphine both increase sedation. Use Caution/Monitor.cinnarizinecinnarizine and buprenorphine both increase sedation. Use Caution/Monitor.clemastineclemastine and buprenorphine both increase sedation. Use Caution/Monitor.clobazambuprenorphine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipraminebuprenorphine and clomipramine both increase sedation. Use Caution/Monitor.clonazepamclonazepam and buprenorphine both increase sedation. Use Caution/Monitor.clorazepateclorazepate and buprenorphine both increase sedation. Use Caution/Monitor.clozapinebuprenorphine and clozapine both increase sedation. Use Caution/Monitor.cobicistatcobicistat will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.codeinebuprenorphine and codeine both increase sedation. Use Caution/Monitor.crizotinibcrizotinib 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.crofelemercrofelemer 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.cyclizinecyclizine and buprenorphine both increase sedation. Use Caution/Monitor.cyclobenzaprinecyclobenzaprine and buprenorphine both increase sedation. Use Caution/Monitor.cyproheptadinecyproheptadine and buprenorphine both increase sedation. Use Caution/Monitor.dabrafenibdabrafenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dantrolenedantrolene and buprenorphine both increase sedation. Use Caution/Monitor.daridorexantbuprenorphine 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. darunavirdarunavir 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.desfluranedesflurane and buprenorphine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required. desipraminebuprenorphine and desipramine both increase sedation. Use Caution/Monitor.deutetrabenazinebuprenorphine 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).dexamethasonedexamethasone will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dexchlorpheniraminedexchlorpheniramine and buprenorphine both increase sedation. Use Caution/Monitor.dexfenfluraminebuprenorphine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexmedetomidinedexmedetomidine and buprenorphine both increase sedation. Use Caution/Monitor.dextromoramidebuprenorphine and dextromoramide both increase sedation. Use Caution/Monitor.diamorphinebuprenorphine and diamorphine both increase sedation. Use Caution/Monitor.diazepamdiazepam and buprenorphine both increase sedation. Use Caution/Monitor.difelikefalindifelikefalin and buprenorphine both increase sedation. Use Caution/Monitor.difenoxin hclbuprenorphine and difenoxin hcl both increase sedation. Use Caution/Monitor.dimenhydrinatedimenhydrinate and buprenorphine both increase sedation. Use Caution/Monitor.diphenhydraminediphenhydramine and buprenorphine both increase sedation. Use Caution/Monitor.diphenoxylate hclbuprenorphine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.dipipanonebuprenorphine and dipipanone both increase sedation. Use Caution/Monitor.dopexaminebuprenorphine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dosulepinbuprenorphine and dosulepin both increase sedation. Use Caution/Monitor.doxepinbuprenorphine and doxepin both increase sedation. Use Caution/Monitor.doxylaminedoxylamine and buprenorphine both increase sedation. Use Caution/Monitor.droperidolbuprenorphine and droperidol both increase sedation. Use Caution/Monitor.efavirenzefavirenz will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.elagolixelagolix will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.elvitegravir/cobicistat/emtricitabine/tenofovir DFelvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.encorafenibencorafenib, buprenorphine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.enzalutamideenzalutamide will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.esketamine intranasalesketamine intranasal, buprenorphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.eslicarbazepine acetateeslicarbazepine acetate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.estazolamestazolam and buprenorphine both increase sedation. Use Caution/Monitor.ethanolbuprenorphine and ethanol both increase sedation. Use Caution/Monitor.etomidateetomidate and buprenorphine both increase sedation. Use Caution/Monitor.etravirineetravirine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fedratinibfedratinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.fenfluraminebuprenorphine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.flibanserinbuprenorphine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.fluphenazinebuprenorphine and fluphenazine both increase sedation. Use Caution/Monitor.buprenorphine and fluphenazine both increase QTc interval. Use Caution/Monitor.flurazepamflurazepam and buprenorphine both increase sedation. Use Caution/Monitor.fosamprenavirfosamprenavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .fosphenytoinfosphenytoin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.gabapentingabapentin, 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.gabapentin enacarbilgabapentin enacarbil, 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.ganaxolonebuprenorphine and ganaxolone both increase sedation. Use Caution/Monitor.haloperidolbuprenorphine and haloperidol both increase sedation. Use Caution/Monitor.hydromorphonebuprenorphine and hydromorphone both increase sedation. Use Caution/Monitor.hydroxyzinehydroxyzine and buprenorphine both increase sedation. Use Caution/Monitor.hydroxyzine and buprenorphine both increase QTc interval. Modify Therapy/Monitor Closely. If coadministration necessary, consider consider dose reduction of one or both drugs due to potential for additive pharmacological effectsiloperidonebuprenorphine and iloperidone both increase sedation. Use Caution/Monitor.iloperidone increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.imipraminebuprenorphine and imipramine both increase sedation. Use Caution/Monitor.indinavirindinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .istradefyllineistradefylline will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.ketamineketamine and buprenorphine both increase sedation. Use Caution/Monitor.ketotifen, ophthalmicbuprenorphine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.lasmiditanlasmiditan, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.lemborexantlemborexant, buprenorphine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.lenacapavirlenacapavir will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. When initiating buprenorphine while on lenacapavir, use lowest feasible initial or maintenance dose of buprenorphine and carefully titrate dose to desired effect. When initiating lenacapavir while taking buprenorphine, consider adjusting dose for buprenorphine. Monitor clinical signs and symptoms. letermovirletermovir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levorphanolbuprenorphine and levorphanol both increase sedation. Use Caution/Monitor.lofepraminebuprenorphine and lofepramine both increase sedation. Use Caution/Monitor.lofexidinebuprenorphine and lofexidine both increase sedation. Use Caution/Monitor.lopinavirlopinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity.loprazolamloprazolam and buprenorphine both increase sedation. Use Caution/Monitor.lorazepamlorazepam and buprenorphine both increase sedation. Use Caution/Monitor.lorlatiniblorlatinib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.lormetazepamlormetazepam and buprenorphine both increase sedation. Use Caution/Monitor.loxapinebuprenorphine and loxapine both increase sedation. Use Caution/Monitor.loxapine inhaledbuprenorphine and loxapine inhaled both increase sedation. Use Caution/Monitor.lumacaftor/ivacaftorlumacaftor/ivacaftor will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.lurasidonelurasidone,