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Drug Interactions between Bunavail and Choletec

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

buprenorphine mebrofenin

Applies to: Bunavail (buprenorphine / naloxone) and Choletec (mebrofenin)

MONITOR: Prior administration of opioids may delay transit of Technetium Tc 99m mebrofenin due to opioid-induced contraction of the distal common bile duct, which may result in nonvisualization. In one study, a group of investigators reviewed the records of 198 emergency department patients who underwent nuclear hepatobiliary imaging, after excluding those with evidence for pathologic common bile duct (CBD) obstruction. Delayed CBD visualization occurred in 28.6% of subjects who had received opioids (n=56) and 12.0% of subjects who had not received opioids, while delayed imaging was performed in 77.8% and 53.5%, respectively. The relative risk of delayed CBD visualization was 1.46 for meperidine, 4.18 for morphine, and 2.38 for any opioid. Nonetheless, low-dose intravenous morphine has been used during cholescintigraphy to increase biliary pressure, thereby allowing for visualization of gallbladder when there is failure to visualize 60 minutes or more after Technetium Tc 99m mebrofenin injection. Compared to standard cholescintigraphy, morphine-augmented cholescintigraphy has been shown to reduce imaging time and the number of false-positive results.

MANAGEMENT: Nonvisualization may occur in patients who have been receiving opioids prior to cholescintigraphy.

References

  1. (2012) "Product Information. Choletec (mebrofenin)." Bracco Diagnostics Inc
  2. Kim EE, Pjura G, Lowry P, Nguyen M, Pollack M (1986) "Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis." AJR Am J Roentgenol, 147, p. 1177-9
  3. Fink-Bennett D, Balon H, Robbins T, Tsai D (1991) "Morphine-augmented cholescintigraphy: its efficacy in detecting acute cholecystitis." J Nucl Med, 32, p. 1231-3
  4. Flancbaum L, Choban PS, Sinha R, Jonasson O (1994) "Morphine cholescintigraphy in the evaluation of hospitalized patients with suspected acute cholecystitis." Ann Surg, 220, p. 25-31
  5. Chen CC, Holder LE, Maunoury C, Drachenberg CI (1997) "Morphine augmentation increases galllbladder visualization in patients pretreated with cholecystokinin." J Nucl Med, 38, p. 644-7
  6. Oates E, Selland DL, Chin CT, Achong DM (1996) "Gallbladder nonvisualization with pericholecystic rim sign: morphine-augmentation optimizes diagnosis of acute cholecystitis." J Nucl Med, 37, p. 267-9
View all 6 references

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Drug and food interactions

Major

buprenorphine food

Applies to: Bunavail (buprenorphine / naloxone)

GENERALLY AVOID: Concomitant use of buprenorphine with benzodiazepines or other central nervous system (CNS) depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol) may increase the risk of buprenorphine overdose, severe respiratory depression, coma, and death. Reported cases have primarily occurred in the setting of buprenorphine maintenance treatment for opiate addiction, and many, but not all, involved abuse or misuse of buprenorphine including intravenous self-injection. The mechanism of interaction probably involves some degree of additive pharmacologic effects. Preclinical studies also suggest that benzodiazepines can alter the usual ceiling effect on buprenorphine-induced respiratory depression and render the respiratory effects of buprenorphine appear similar to those of full opioid agonists. Coadministration of buprenorphine with some CNS depressants such as alcohol, benzodiazepines, and phenothiazines may also increase the risk of hypotension.

MANAGEMENT: The use of opioids in conjunction with benzodiazepines or other CNS depressants should generally be avoided unless alternative treatment options are inadequate. If coadministration is necessary, the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect. Patients should be monitored closely for signs and symptoms of respiratory depression and sedation, and advised to avoid driving or operating hazardous machinery until they know how these medications affect them. Extreme caution is advised when prescribing buprenorphine to patients who are addicted to opioids and also abusing benzodiazepines or alcohol. Due to potential risk of overdose and death, dependence on sedative-hypnotics such as benzodiazepines or alcohol is considered a relative contraindication for office-based buprenorphine treatment of opioid addiction. For patients who have been receiving extended therapy with both an opioid and a benzodiazepine and require discontinuation of either medication, a gradual tapering of dose is advised, since abrupt withdrawal may lead to withdrawal symptoms. Severe cases of benzodiazepine withdrawal, primarily in patients who have received excessive doses over a prolonged period, may result in numbness and tingling of extremities, hypersensitivity to light and noise, hallucinations, and epileptic seizures.

References

  1. (2002) "Product Information. Suboxone (buprenorphine-naloxone)." Reckitt and Colman Pharmaceuticals Inc
  2. Kilicarslan T, Sellers EM (2000) "Lack of interaction of buprenorphine with flunitrazepam metabolism." Am J Psychiatry, 157, p. 1164-6
  3. Reynaud M, Petit G, Potard D, Courty P (1998) "Six deaths linked to concomitant use of buprenorphine and benzodiazepines." Addiction, 93, p. 1385-92
  4. Tracqui A, Kintz P, Ludes B (1998) "Buprenorphine-related deaths among drug addicts in France: a report on 20 fatalities." J Anal Toxicol, 22, p. 430-4
  5. Reynaud M, Tracqui A, Petit G, Potard D, Courty P (1998) "Six deaths linked to misuse of buprenorphine-benzodiazepine combinations." Am J Psychiatry, 155, p. 448-9
  6. Kintz P (2002) "A new series of 13 buprenorphine-related deaths." Clin Biochem, 35, p. 513-6
  7. Martin HA (2011) "The possible consequences of combining lorazepam and buprenorphine/naloxone: a case review." J Emerg Nurs, 37, p. 200-2
  8. Hakkinen M, Launiainen T, Vuori E, Ojanpera I (2012) "Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning." Eur J Clin Pharmacol, 68, p. 301-9
  9. Substance Abuse and Mental Health Services Administration (US) (2013) Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series, No. 40 http://www.ncbi.nlm.nih.gov/books/NBK64245/
  10. Schuman-Olivier Z, Hoeppner BB, Weiss RD, Borodovsky J, Shaffer HJ, Albanese MJ (2013) "Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes." Drug Alcohol Depend, 132, p. 580-6
  11. Ferrant O, Papin F, Clin B, et al. (2011) "Fatal poisoning due to snorting buprenorphine and alcohol consumption." Forensic Sci Int, 204, e8-11
  12. Pirnay S, Borron SW, Giudicelli CP, Tourneau J, Baud FJ, Ricordel I (2004) "A critical review of the causes of death among post-morten toxicological investigations: analysis of 34 buprenorphine-associated and 35 methadone-associated deaths." Addiction, 99, p. 978-88
  13. Kintz P (2001) "Deaths involving buprenorphine: a compendium of French cases." Forensic Sci Int, 121, p. 65-9
  14. Sekar M, Mimpriss TJ (1987) "Buprenorphine, benzodiazepines and prolonged respiratory depression." Anaesthesia, 42, p. 567-8
  15. Gueye PN, Borron SW, Risede P, et al. (2002) "Buprenorphine and midazolalm act in combination to depress respiration in rats." Toxicol Sci, 65, p. 107-14
  16. US Food and Drug Administration (2016) FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM518672.pdf
View all 16 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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