Table 3.

BPN pharmacological interactions

Drug	Effect	Management
Severe interactions
Benzondiazepines, muscle relaxants, anesthetics, antipsychotics, alcohol and opioids	Increases the risk of BPN overdose, hypotension, respiratory depression, coma, and death Alters the usual ceiling effect on respiratory depression induced by BPN Precipitation of withdrawal symptoms and/or decrease in the analgesic effect of BPN after combination with mixed agonist opioids or antagonists	Coadministration of these drugs should be avoided Extreme patient vigilance is required if concomitant use with CNS depressants is necessary85–88
Pregabalin	Increases the risk of BPN overdose, hypotension, respiratory depression, coma, and death. Alters the usual ceiling effect on respiratory depression induced by BPN	Coadministration with BPN should be avoided89
Escitalopram	Increases the risk of a life-threatening irregular heart rhythm	Caution is advised90
Moderate interactions
Albuterol	Increases the risk of an irregular heart rhythm, which can be serious and fatal; however, this is a rare side effect	Avoid concomitant use91
Duloxetine	Dizziness, drowsiness, confusion, and difficulty in concentrating	Coadministration should be avoided92
Fluoxetine	Dizziness, drowsiness, confusion, and difficulty in concentrating. Norfluoxetine (active metabolite) inhibits BPN dealkylation	During concomitant use, dosage adjustment may be necessary92,93
Quetiapine	Increases the risk of an irregular heart rhythm, which can be serious and life threatening, but is rare	Caution and clinical monitoring if concomitant use is required94,95
Laxatives (Senna)	Irregular heartbeat, which can be severe and life threatening, but is rare	Caution in coadministration96

Abbreviations: BPN, buprenorphine; CNS, central nervous system.