What medications can you NOT take with Suboxone?
Buprenorphine, the active drug in Suboxone, is a partial opioid agonist. That means it works partially like an opioid, but its effects are weaker than drugs like heroin or methadone. It lowers the effects of withdrawal symptoms and reduces cravings for other opioids.
Naloxone is an opioid antagonist, or "blocker." It is only absorbed if Suboxone is injected instead of being dissolved in the mouth as prescribed. If injected, it causes uncomfortable withdrawal symptoms in order to discourage IV use.
Suboxone is safe and effective when used as prescribed, but it can cause serious side effects when used with many other medications. Drugs that can have negative effects when taken with Suboxone include:
- Benzodiazepines, such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam) and Restoril (temazepam). When used improperly, they can result in slowed breathing or even death.
- Rifampin (a treatment for tuberculosis)
- St. John's wort (an herbal remedy purported to have antidepressant properties)
These medications may increase the effects of Suboxone:
- Some antibiotics, including Biaxin (clarithromycin) and Ery-Tab (erythromycin)
- Some antidepressants, including Prozac (fluoxetine) and Nardil (phenelzine)
- Antifungals, such as Diflucan (fluconazole), Nizoral (ketoconazole) and Sporanox (itraconazole)
- HIV medications known as protease inhibitors: Crixivan (indinavir), Norvir (ritonavir), Fortovase and Invirase (saquinavir) and Kaletra (lopinavir/ritonavir)
These medications may decrease the effects of Suboxone:
- Some seizure medications, including phenobarbital, Tegretol (carbamazepine) and Dilantin (phenytoin)
- Rifadin (rifampin)
- Revia, Vivitrol (naltrexone)
It's important to tell your doctor about medicines you are taking while you're on Suboxone, including prescription drugs, over-the-counter medicine, vitamins and herbal supplements. Also avoid drinking alcohol, taking sedatives or other opioid pain medication, or using illegal drugs while on Suboxone.
- National Alliance on Mental Illness (NAMI). Buprenorphine/naloxone (Suboxone). January 2021. Available at: https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). [Accessed March 19, 2021].
- McCance-Katz E, Sullivan L, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010 Jan-Feb; 19(1): 4-16. https://doi.org/10.1111/j.1521-0391.2009.00005.x.
- Substance Abuse and Mental Health Services Administration (SAMHSA). Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. 2004. Available at: https://www.naabt.org/documents/TIP40.pdf. [Accessed March 19, 2021].
- U.S. National Library of Medicine. Buprenorphine sublingual and buccal (opioid dependence). December 15, 2020. Available at: https://medlineplus.gov/druginfo/meds/a605002.html. [Accessed March 19, 2021].
- Indivior. Suboxone (medication guide). March 2021. Available at: https://www.suboxone.com/pdfs/medication-guide.pdf. [Accessed March 19, 2021].
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