in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.hydroxychloroquine sulfateSerious - Use Alternative (1)buprenorphine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.hydroxyzineMonitor Closely (2)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 effects hydroxyzine and buprenorphine both increase sedation. Use Caution/Monitor.ibutilideSerious - Use Alternative (1)buprenorphine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.idelalisibSerious - Use Alternative (1)idelalisib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substratesiloperidoneMonitor Closely (2)buprenorphine 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.Serious - Use Alternative (1)buprenorphine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.imipramineMonitor Closely (1)buprenorphine and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.indinavirMonitor Closely (1)indinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .inotuzumabSerious - Use Alternative (1)buprenorphine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.isocarboxazidSerious - Use Alternative (1)isocarboxazid increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.isofluraneSerious - Use Alternative (1)isoflurane and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.istradefyllineMonitor Closely (1)istradefylline 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.itraconazoleSerious - Use Alternative (2)itraconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. itraconazole and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.ivosidenibSerious - Use Alternative (2)ivosidenib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. buprenorphine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.ketamineMonitor Closely (1)ketamine and buprenorphine both increase sedation. Use Caution/Monitor.ketoconazoleSerious - Use Alternative (1)ketoconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.ketotifen, ophthalmicMonitor Closely (1)buprenorphine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.lapatinibSerious - Use Alternative (1)buprenorphine and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.larotrectinibMinor (1)larotrectinib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.lasmiditanMonitor Closely (1)lasmiditan, 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.lefamulinContraindicated (1)lefamulin will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.Serious - Use Alternative (1)buprenorphine and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.lemborexantMonitor Closely (1)lemborexant, 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.lenacapavirMonitor Closely (1)lenacapavir 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. lenvatinibSerious - Use Alternative (1)buprenorphine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.letermovirMonitor Closely (1)letermovir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.leuprolideSerious - Use Alternative (1)buprenorphine and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.levofloxacinSerious - Use Alternative (1)buprenorphine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.levoketoconazoleSerious - Use Alternative (1)levoketoconazole will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.levorphanolMonitor Closely (1)buprenorphine and levorphanol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, levorphanol. 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.lidocaineMinor (1)lidocaine increases toxicity of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.linezolidSerious - Use Alternative (1)linezolid increases toxicity of buprenorphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.lithiumSerious - Use Alternative (1)lithium and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.lofepramineMonitor Closely (1)buprenorphine and lofepramine both increase sedation. Use Caution/Monitor.lofexidineMonitor Closely (1)buprenorphine and lofexidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.lonafarnibSerious - Use Alternative (1)lonafarnib will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.loperamideSerious - Use Alternative (1)buprenorphine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.lopinavirMonitor Closely (1)lopinavir 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 lopinavir both increase QTc interval. Avoid or Use Alternate Drug.loprazolamMonitor Closely (1)loprazolam and buprenorphine both increase sedation. Use Caution/Monitor.lorazepamMonitor Closely (1)lorazepam and buprenorphine both increase sedation. Use Caution/Monitor.lorlatinibMonitor Closely (1)lorlatinib will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.lormetazepamMonitor Closely (1)lormetazepam and buprenorphine both increase sedation. Use Caution/Monitor.loxapineMonitor Closely (1)buprenorphine and loxapine both increase sedation. Use Caution/Monitor.loxapine inhaledMonitor Closely (1)buprenorphine and loxapine inhaled both increase sedation. Use Caution/Monitor.lumacaftor/ivacaftorMonitor Closely (1)lumacaftor/ivacaftor will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.lurasidoneMonitor Closely (1)lurasidone, 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.macimorelinSerious - Use Alternative (1)buprenorphine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.maprotilineMonitor Closely (2)buprenorphine and maprotiline both increase QTc interval. Use Caution/Monitor. buprenorphine and maprotiline both increase sedation. Use Caution/Monitor.marijuanaMonitor Closely (1)buprenorphine and marijuana both increase sedation. Use Caution/Monitor.mavacamtenMonitor Closely (1)buprenorphine 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. mefloquineSerious - Use Alternative (1)buprenorphine and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.melatoninMonitor Closely (1)buprenorphine and melatonin both increase sedation. Use Caution/Monitor.meperidineMonitor Closely (1)buprenorphine and meperidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, meperidine. 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.meprobamateMonitor Closely (1)buprenorphine and meprobamate both increase sedation. Use Caution/Monitor.metaxaloneMonitor Closely (1)metaxalone and buprenorphine both increase sedation. Use Caution/Monitor.methadoneMonitor Closely (1)buprenorphine and methadone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)buprenorphine, methadone. 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. buprenorphine and methadone both increase QTc interval. Avoid or Use Alternate Drug.methocarbamolMonitor Closely (1)methocarbamol and buprenorphine both increase sedation. Use Caution/Monitor.methylene blueSerious - Use Alternative (1)methylene blue and buprenorphine both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicitiesmethylenedioxymethamphetamineMonitor Closely (1)buprenorphine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.metoclopramide intranasalSerious - Use Alternative (1)buprenorphine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.midazolamMonitor Closely (1)midazolam and buprenorphine both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam 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.midostaurinSerious - Use Alternative (1)buprenorphine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mifepristoneSerious - Use Alternative (2)mifepristone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. buprenorphine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.mirtazapineMonitor Closely (1)buprenorphine and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.mitotaneMonitor Closely (1)mitotane will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.mobocertinibSerious - Use Alternative (1)buprenorphine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.morphineMonitor Closely (1)buprenorphine and morphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.motherwortMonitor Closely (1)buprenorphine and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinSerious - Use Alternative (1)buprenorphine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.moxonidineMonitor Closely (1)buprenorphine and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)buprenorphine and nabilone both increase sedation. Use Caution/Monitor.nafcillinMonitor Closely (1)nafcillin will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nalbuphineMonitor Closely (1)buprenorphine and nalbuphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, 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.naldemedineSerious - Use Alternative (1)naldemedine, 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.naloxegolSerious - Use Alternative (1)naloxegol, 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.nefazodoneSerious - Use Alternative (1)nefazodone will increase the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.nelfinavirMonitor Closely (1)nelfinavir increases levels of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. .nevirapineMonitor Closely (1)nevirapine will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nilotinibSerious - Use Alternative (1)buprenorphine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.nortriptylineMonitor Closely (1)buprenorphine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.octreotideSerious - Use Alternative (1)buprenorphine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.ofloxacinSerious - Use Alternative (1)buprenorphine and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.olanzapineMonitor Closely (1)buprenorphine and olanzapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. If concurrent use of olanzapine and buprenorphine is necessary, consider dose reduction of one or both drugs.oliceridineMonitor Closely (1)oliceridine, 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.Serious - Use Alternative (1)buprenorphine, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.olopatadine intranasalSerious - Use Alternative (1)buprenorphine and olopatadine intranasal both increase sedation. Avoid or