Buprenorphine- Interactions and Warnings

– Interactions and Warnings

All subjects were opiate addicts taking high-dosage sublingual buprenorphine formulation as substitution therapy. Almost all cases involved concomitant intake of psychotropic medications, especially benzodiazepines (18 non-fatal and 17 fatal cases). Observations confirm previously reported data on the danger of buprenorphine-benzodiazepine combinations. Intravenous injection of crushed tablets also appears to be a risk factor (8 deaths and 10 non-fatal poisonings). This series highlights the need for improvement in the recently developed French program for substitution therapy with high-dosage buprenorphine in heroin addicts.
– Presse Med 1998 Mar 28;27(12):557-61 — Acute poisoning during substitution therapy based on high-dosage buprenorphine. 29 clinical cases–20 fatal cases. — Tracqui A, Tournoud C, Flesch F, Kopferschmitt J, Kintz P, Deveaux M, Ghysel MH, Marquet P, Pepin G, Petit G, Jaeger A, Ludes B.

Paper contains a clinical observation of respiratory depression following the administration of buprenorphine as postoperative analgesic after balanced anaesthesia with fentanyl. The observed case is interpreted in the light of the pharmacokinetics and pharmacodynamics of the different classes of opioid drugs (agonists, agonists-antagonists, antagonists) and of the interactions with their respective receptors.
– Paediatr Anaesth 1996;6(5):419-22 — Respiratory depression following administration of low dose buprenorphine as postoperative analgesic after fentanyl balanced anaesthesia. — Zanette G, Manani G, Giusti F, Pittoni G, Ori C.

A 48-year-old man who had undergone thoracotomy for carcinoma of the middle third of his oesophagus developed severe postoperative respiratory depression following intramuscular ketorolac 30 mg 2 h after 150 micrograms epidural buprenorphine. Summation of analgesia by drugs used in combination can have deleterious respiratory effects.
– Anaesthesia 1993 Oct;48(10):898-9 — Respiratory depression following combination of epidural buprenorphine and intramuscular ketorolac. — Jain PN, Shah SC.

The results suggest that both buprenorphine and amitriptyline moderately affect psychomotor performance but the interaction between these agents is mild and restricted mainly to respiration.
– Eur J Clin Pharmacol 1987;33(2):139-46 — Psychomotor, respiratory and neuroendocrinological effects of buprenorphine and amitriptyline in healthy volunteers. — Saarialho-Kere U, Mattila MJ, Paloheimo M, Seppala T.

High dosages can cause fatal respiratory depression. The use of benzodiazepines may have been a co-factor in the toxic effects of buprenorphine.
– J Forensic Sci 2000 Jan;45(1):226-8 — Fatal intoxication following self-administration of a massive dose of buprenorphine. — Gaulier JM, Marquet P, Lacassie E, Dupuy JL, Lachatre G.

Diltiazem may have an adverse effect on naloxone.
– Eur J Pharmacol 1996 Nov 28;316(1):7-14 — Diltiazem inhibits naloxone-precipitated and spontaneous morphine withdrawal in rats. — Kishioka S, Inoue N, Nishida S, Fukunaga Y, Yamamoto H.

Buprenorphine has been associated with deaths due to diminished breathing, especially when used in combination with alcohol or other Central Nervous System (CNS) depressant drugs, according to reports from France where it has been available for several years. Use caution and consult with your physician – this drug can interact with several different categories of prescription medications. Do not mix with alcohol.

The most common reported side effect of Subutex and Suboxone include cold or flu-like symptoms, headaches, sweating, sleeping difficulties, nausea and mood swings.

Do not use if you are pregnant, planning to be or breastfeeding.

Consult with your physician before taking herbs, vitamins or supplements.

last update: November 2008

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