Drug Interactions between buprenorphine and dihydrocodeine / phenylephrine

GENERALLY AVOID: Concomitant use of opioids with other central nervous system (CNS) depressants including mixed agonist-antagonist or partial agonist opioids may result in profound sedation, respiratory depression, coma, and death. The risk of hypotension may also be increased. On the other hand, mixed agonist-antagonist or partial agonist opioids can reduce the pharmacologic effects of other opioid agonists. Reduced efficacy or withdrawal symptoms may occur in patients maintained on their opioid regimen following the addition of a mixed agonist-antagonist or partial agonist opioid.

MANAGEMENT: The use of opioids in conjunction with other CNS depressants including mixed agonist-antagonist or partial agonist opioids should generally be avoided unless alternative treatment options are inadequate. If coadministration is necessary (e.g., when initiating a switch from one opioid to the other), the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect, and patients should be closely monitored for signs and symptoms of CNS and respiratory depression. Additional caution is advisable when a mixed agonist-antagonist or partial agonist opioid is added to an existing opioid regimen, as there may be an increased risk of withdrawal symptoms (e.g., restlessness, insomnia, sweating, lacrimation, or rhinorrhea) following initiation of the mixed agonist-antagonist or partial agonist opioid. A dosage adjustment for one or both drugs may be required.