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Alcohol

Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop

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Interaction
a) In a randomized study of 12 patients undergoing opioid substitution treatment (other groups took methadone, levo-a-acetylmethadol (LAAM) or placebo) receiving 14.7 g/70 kg alcohol, the group taking buprenorphine had lower mean blood alcohol content (BAC) (mean BAC=0.040) compared with the control group (mean BAC=0.056). These findings were not statistically significant.

b) A study in 21 patients taking buprenorphine or methadone found that alcohol decreased driving performance similarly in the methadone/buprenorphine group and the control group. Blood alcohol concentrations were also lower in the buprenorphine/methadone group.

c) As a CNS depressant, buprenorphine has the potential to enhance the adverse or toxic effects of other CNS depressants, such as alcohol. Combined use of opioids and alcohol may lead to sedation and respiratory depression.

A case report describes the death of a 40 year old male who was found to have a blood alcohol level of 1.96g/L as well as buprenorphine (at therapeutic levels), clonazepam, and oxazepam in his blood. The cause of death was suggested to be respiratory depression.

Mechanism
a,b) It is hypothesized that the reduction in mean BAC is due to buprenorphine-induced delays in gastric emptying.

c) Additive CNS depression.

Significance
a,b) Given the lack of statistically significant difference observed in this study, further research is necessary.

c) It is important to warn patients of the potential for a reduction in psychomotor function. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

Serious Risk for Harm

Buprenorphine and alcohol are both 'CNS depressants', which means they slow the brain. Buprenorphine can cause sleepiness, dizziness and confusion. Alcohol can make this worse, and make it more dangerous to drive or do activities that require alertness and attention. Mixing buprenorphine with alcohol may cause dangerously slowed breathing, and even death.

Tobacco

smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip

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Interaction
In a retrospective study of 69 smokers and 20 non-smokers hospitalized for a coronary artery bypass graft (CABG) procedure, smokers were found to have needed 29-33% more opioid analgesia (normalized to mg morphine equivalents) when normalized for weight and BMI, compared to non-smokers in the first 48 hours after surgery (a statistically significant finding).

Another retrospective study in 171 women found that the average post-operative narcotic use over 12 hours was 10.9 mg morphine equivalents in non-smokers compared to 13 mg for former smokers and 13.1 mg for current smokers.

A prospective study including 848 patients undergoing surgery compared opiate use during the first 72 hours after surgery. Male smokers required more opiate analgesics compared with male non-smokers and past-smokers. Male smokers also reported more pain on day 1 after surgery.

A study involving 7 women during recovery from caesarean delivery found that weight adjusted us of related drug morphine use over 24 hours was 1.8 mg/kg in smokers and 0.64 mg/kg in non-smokers. Another study also found increased morphine requirements in smokers.

Mechanism
Nicotine in cigarettes may blunt a patient’s pain perception (potentially by increasing plasma beta-endorphins), thus increasing baseline patient analgesia prior to hospitalization. When smoking is ceased before surgery, patients may have increased pain perception.

Significance
Knowledge of patient’s current smoking status upon hospitalization or prior to surgery may help optimize initial pain management following a surgical procedure if buprenorphine is being used for pain. If it is used as opioid-dependence treatment the significance is unknown.

Think First

If you take buprenorphine for pain control, smoking cigarettes regularly changes the amount of opioid (like buprenorphine) you require. On-and-off cigarette smoking can make pain relief from use of opioids inconsistent.

Caffeine

coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Cannabis/ Hash

Marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers, shatter, budder

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Interaction

a) Tetrahydrocannabinol (THC), the main active ingredient in cannabis, releases endogenous opioid peptides, dynorphin A to enhance morphine in the spinal cord, indicating a synergistic interaction between the endogenous opioids and cannabinoid system.

b) As a CNS depressant, buprenorphine has the potential to enhance the adverse or toxic effects of other CNS depressants, such as cannabis. Combined use of opioids and cannabis may lead to sedation and respiratory depression.

c) Cannabis use may increase blood levels of buprenorphine.

Mechanism

a) The authors postulate that a cannabinoid receptor linked to the endogenous opioid system may exist.

b) Additive CNS depressant effects.

c) Cannabidiol (CBD) may inhibit CYP3A4, although this has not been shown at doses used in human studies. Buprenorphine is a CYP3A4 substrate.

Significance

a) Discovery of these receptors may be important in future treatments of pain. Cannabis may improve pain and reduce opioid requirements, but more data is required.

b) It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

c) The significance of this interaction is unknown. It could theoretically result in increased buprenorphine toxicity.

Serious Risk for Harm

Buprenorphine and cannabis are both 'CNS depressants', which means they slow the brain. Mixing buprenorphine with cannabis may cause dangerously slowed breathing, and even death. Buprenorphine can cause sleepiness, dizziness and confusion. Cannabis can make this worse, and make it more dangerous to drive or do activities that require alertness and attention.

Serious Risk for Harm

Cannabis may slow down the removal of buprenorphine from your body. This is like taking more buprenorphine than you planned, and could cause serious side effects like sedation, dangerously slowed breathing or death.

Cocaine/ Crack

coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar

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Interaction
a) In a study of 30 patients (outside of opioid dependence) receiving buprenorphine/naloxone 16/4 mg daily for at least 2 weeks, regular cocaine users (>89% urine toxicology screens positive for cocaine metabolites) experienced a decrease in buprenorphine AUC by 34%). However, another study found that peak concentrations of buprenorphine were not different in cocaine users vs non-users.

b) A study found that retention of buprenorphine treatment among opioid-dependent patients was not different in cocaine users vs non-users.

c) The cardiovascular or respiratory effect of a single dose of intravenous cocaine was not changed by buprenorphine 4-8 mg sublingual daily x 21 days.

d) Studies investigating the effect of buprenorphine on QTc interval have found that buprenorphine at therapeutic doses (10 mcg/hr patch) did not affect the QTc interval. However, at supra-therapeutic doses (40 and 80 mcg/hr patch) buprenorphine did prolong the QTc interval similarly to moxifloxacin 400 mg. Another study found that although the QTc interval was prolonged in youth receiving buprenorphine/naloxone, none exceeded 500 msec which is when the risk of Torsades de Pointes becomes more significant. Cocaine may further increase the risk of QTc prolongation and development of Torsades de Pointes. Reports of ventricular arrhythmia and Torsades de Pointes do exist with buprenorphine, although one study found the proportional reporting ratio was not statistically significant.

e) Cocaine may reduce absorption of sublingual formulations of buprenorphine.

Mechanism
a) The mechanism is not understood. Cocaine is thought to inhibit CYP3A4, and buprenorphine is a CYP3A4 substrate, so it is unclear why buprenorphine levels would decrease. Alternatively, some animal data shows that chronic cocaine use may induce CYP enzyme activity.

d) Cocaine is known to prolong the QTc interval. As described above, some evidence shows buprenorphine can prolong the QTc interval, and the effects may be additive.

e) Cocaine-induced vasoconstriction may limit sublingual buprenorphine absorption.

Significance
a) Heavy cocaine users receiving buprenorphine/naloxone treatment for opioid dependence may require higher dosing due to decreased buprenorphine exposure. To achieve best patient outcomes, identification and treatment of concurrent cocaine abuse (in addition to opioid abuse) is necessary.

d) Cocaine use should be discouraged in patients taking buprenorphine due to the increased risk of QTc prolongation and Torsades de Pointes.

e) Cocaine may impair the efficacy of buprenorphine administered sublingually. Alternate dosage forms should be considered in cocaine users.

Serious Risk for Harm

Both cocaine and buprenorphine can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

Think First

Using cocaine together with buprenorphine could work against the helpful effects of buprenorphine. It might not work as well for pain or you might feel signs of opioid withdrawal, such as anxiety, irritability, muscle spasms, and hot and cold sweats.

Think First

If you normally dissolve buprenorphine under your tongue, using cocaine could reduce the amount of buprenorphine you absorb. This could make buprenorphine not work as well as expected. It might not work as well for pain or you might feel signs of opioid withdrawal, such as anxiety, irritability, muscle spasms, and hot and cold sweats.

Opioids

codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean

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Interaction
ALL OPIOIDS: a) As buprenorphine is an opioid itself, concomitant use with another opioid would result in additive effects including adverse/toxic effects. As a CNS depressant, buprenorphine has the potential to enhance the adverse or toxic effects of other CNS depressants, such as other opioids.

Combined use of multiple opioids may lead to sedation and respiratory depression. It can also increase the risk for opioid overdose, which may be fatal (symptoms may include decreased level of consciousness and pinpoint pupils, slowed breathing and heart rate, sometimes to a stop, blue lips and nails due to insufficient oxygen in the blood, seizures and muscle spasms).

b) Concomitant use of buprenorphine and opioids increases the risk of secondary constipation, potentially leading to hemorrhoids, rectal prolapse, and fecal impaction.

FENTANYL: In a randomized double-blind placebo-controlled cross-over study with 15 healthy volunteers, the concomitant use of 0.75 microgram/kg of both fentanyl and buprenorphine produced additive analgesic effects.

FENTANYL, HYDROMORPHONE, METHADONE, MORPHINE, OXYCODONE:Buprenorphine can precipitate opioid withdrawal symptoms in patients taking pure opioid agonists.

A study found that combination buprenorphine/naloxone (Suboxone) reduced the subjective and reinforcing effects of hydromorphone.

LOPERAMIDE: QTc prolongation has been observed with buprenorphine. Concomitant use with high-dose loperamide (>100 mg/day) may result in an arrhythmia with the potential to develop Torsades de Pointes.

METHADONE: Studies investigating the effect of buprenorphine on QTc interval have found that buprenorphine at therapeutic doses (10 mcg/hr patch) did not affect the QTc interval. However, at supra-therapeutic doses (40 and 80 mcg/hr patch) buprenorphine did prolong the QTc interval similarly to moxifloxacin 400 mg. Another study found that although the QTc interval was prolonged in youth receiving buprenorphine/naloxone, none exceeded 500 msec which is when the risk of Torsades de Pointes becomes more significant. Methadone may further increase the risk of QTc prolongation and development of Torsades de Pointes. Reports of ventricular arrhythmia and Torsades de Pointes do exist with buprenorphine, although one study found the proportional reporting ratio was not statistically significant.

Mechanism
ALL OPIOIDS: a) Additive CNS and respiratory depressant effects.

b) Opioids can cause constipation. The effect may be additive with use of multiple opioids.

FENTANYL: Likely via additive analgesic effects, but the mechanism is presently unclear.

FENTANYL, HYDROMORPHONE, METHADONE, MORPHINE, OXYCODONE: Buprenorphine has mixed agonist/antagonist properties – it is a partial agonist at mu-receptors, an antagonist at kappa-receptors and an agonist at delta-receptors. It will not have the same effect as a pure agonist and may prevent the pure agonist from binding to the receptor.

LOPERAMIDE: Both buprenorphine and high dose loperamide can cause QTc interval prolongation. When used together, these effects may be additive.

METHADONE: Both buprenorphine and methadone can cause QTc interval prolongation. When used together, these effects may be additive.

Significance
ALL OPIOIDS: a) Concomitant use of multiple opioids is unusual. It would be important to monitor the patient for any excessive CNS depression. It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

It is important to warn patients to avoid using combinations of opioids if not being monitored closely. Inform patients who use combinations of strong opioids of the signs of opioid overdose, and how they or people around them can get help (by contacting emergency services, or administering naloxone (Narcan) if available).

b) Encourage patients to exercise regularly (ideally 30-60 minutes of aerobic exercise at least 5 times weekly) if possible, maintain a fibre intake of 25-30 grams/day, and not ignore the urge to defecate. Supplementary use of laxatives such as PEG 3350 may be necessary if it has been more than 3 days since they have had a bowel movement, or if constipation has become a chronic condition. Attempt to use the lowest effective dose of each agent to minimize this adverse effect.

FENTANYL, HYDROMORPHONE, METHADONE, MORPHINE, OXYCODONE: Monitor patients for symptoms of opioid withdrawal (anxiety, irritability, hot/cold sweats, muscle spasms). Caution patient to avoid using opioids other than their prescribed dosing regimen.

LOPERAMIDE: Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of high-dose loperamide (>100 mg/day) and buprenorphine.

METHADONE: If deemed necessary, methadone should be used very cautiously in patients taking buprenorphine due to the increased risk of QTc prolongation and Torsades de Pointes.

Serious Risk for Harm

Buprenorphine and other opioids are 'CNS depressants' which means they slow the brain. Mixing buprenorphine with opioids may cause dangerously slowed breathing and even death. Together they also cause sleepiness, dizziness, confusion and make it more dangerous to drive or do activities that require alertness and attention.

Serious Risk for Harm

LOPERAMIDE: Use of both buprenorphine and very high doses of loperamide (more than 100 mg in one day) can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

METHADONE: Use of methadone with buprenorphine could cause your heart to have an abnormal rhythm. This abnormal heart rhythm could make you feel dizzy, pass out, or even kill you.

Think First

FENTANYL, HYDROMORPHONE, METHADONE, MORPHINE, OXYCODONE: Buprenorphine can make some opioids work less well than expected for pain.

Amphetamines/ Stimulants

uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9

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Interaction

a) Dextroamphetamine and methylphenidate have been shown to increase the analgesic effects of related medication morphine. Dextroamphetamine (0.215 mg/kg) combined with low-dose morphine (0.15 mg/kg) increased the analgesic effect and antagonized respiratory depression of morphine for more than five hours. Dextroamphetamine combined with high-dose morphine (0.3 mg/kg) was unable to completely reduce the respiratory depressant effect, and some residual effects of morphine persisted at 23 hours.

Methylphenidate reduced the sedative effects of opioids in 28 chronic cancer pain patients and increased analgesic effects.

b) A retrospective study found that mechanically ventilated trauma patients who had used amphetamines before admission had similar opioid requirements to those who had a negative urine drug screen for amphetamines.

c) In a 17 day randomized trial of 40 males with methamphetamine use disorder, buprenorphine 8 mg/daily was superior to methadone 40 mg daily for reduction of methamphetamine cravings.

Mechanism

c) The authors theorized that opioids may be effective replacement strategies for methamphetamine use because the mechanisms of methamphetamine and opioid dependence are similar because both drugs involve the endogenous opioid system.

Significance

a,b) Combination dextroamphetamine-morphine has been shown to provide increased analgesia with fewer side effects while increasing the analgesia-to-respiratory depression ratio. Combination methylphenidate-morphine has been shown to provide increased analgesia with reduced sedation. This combination may be useful in the post-operative setting. However, the study described in b) shows that this may not always be the case, and it may not be appropriate to empirically reduce analgesic doses in patients using amphetamines. It is not known whether these results generalize to buprenorphine.

c) Further studies are required to confirm buprenorphine’s effectiveness in the treatment of methamphetamine use disorder.

Think First

For some medical reasons your doctor may prescribe buprenorphine and an amphetamine or stimulant together, but using amphetamines or stimulants without your doctor knowing is a risk.

Phencyclidine/ Ketamine

PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®

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Interaction
KETAMINE: a) As a CNS depressant, buprenorphine has the potential to enhance the adverse or toxic effects of other CNS depressants, such as ketamine. Combined use of opioids and ketamine may lead to sedation and respiratory depression.

b) Various studies have investigated the use of adjunctive ketamine peri-operatively or post-operatively. Some of the studies have found that ketamine reduces intra-operative opioid requirements, post-op pain and opioid consumption, and post-op nausea and vomiting. However, other studies have not found statistically significant differences for these results.

c) A review found that ketamine may be effective as an alternative or adjunct to opioids for acute pain in the emergency department when patients do not respond to conventional therapies.

PHENCYCLIDINE: No information currently available.

Mechanism
KETAMINE: a) Additive CNS depression.

Significance
KETAMINE: a) It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

b,c) Ketamine may be effective as an adjunctive analgesic for post-op pain and to reduce post-op nausea/vomiting, as well as for acute pain. However, the evidence is still conflicting. The current studies did not report an increase in serious adverse effects with the combination.

Serious Risk for Harm

KETAMINE: Buprenorphine and ketamine are 'CNS depressants' which means they slow the brain. Mixing buprenorphine with ketamine may cause slowed breathing, and even death. Together they also cause sleepiness, dizziness, confusion and make it more dangerous to drive or do activities that require alertness and attention.

Unknown Dangers

PHENCYCLIDINE: Unknown dangers.

LSD/ Hallucinogens

acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Benzodiazepines

benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill)

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Interaction
ALL BENZODIAZEPINES: a) As a CNS depressant, buprenorphine has the potential to enhance the adverse or toxic effects of other CNS depressants, such as benzodiazepines. Combined use of opioids and benzodiazepines may lead to sedation and respiratory depression.

b) Benzodiazepines have been implicated in the sudden death of patients who abuse opioids. Case reports of sudden death via respiratory depression have been reported from the concomitant use of buprenorphine and benzodiazepines.

An 8-year retrospective analysis of American Poison Center calls related to buprenorphine and methadone was performed. There were 692 methadone-benzodiazepine exposure cases and 72 buprenorphine-benzodiazepine exposure cases. Use of naloxone and intubation was 4 times as likely and hospitalization was 50% more likely with methadone-benzodiazepine exposures compared to buprenorphine-benzodiazepine exposures. While there were no deaths associated with buprenorphine-benzodiazepine exposure, there were 16 deaths associated with methadone-benzodiazepine exposure.

c) A study found that in chronic pain patients, benzodiazepine use was associated with increased self-reported pain severity and use of higher doses of opioids. Some data shows that diazepam may increase pain scores in patients taking related drug morphine. Alternatively, midazolam appears to reduce the dose of morphine required for post-op analgesia.

DIAZEPAM: a) Related drug morphine delayed the absorption of diazepam.

b) In a double-blind study of 7 patients receiving a stable average of buprenorphine 11.1 +/- 2.8 mg daily for at least 2 weeks and receiving one of 4 treatments (diazepam 0 mg + 100% buprenorphine dose, diazepam 40 mg + 100% buprenorphine, diazepam 0 mg + 150% buprenorphine, diazepam 40 mg + 150% buprenorphine), the introduction of diazepam increased subjective sedation reporting, particularly 1-3 hours post-administration. Objective performance tasks such as reaction time deteriorated after diazepam administration. No significant changes in peak of drug effect due to diazepam administration were found. No significant changes in oxygen saturation (safety monitoring parameter) were detected. Another study found similar results.

Mechanism
ALL BENZODIAZEPINES: a) Additive CNS depressant effects.

DIAZEPAM: a) Opioids delay gastric emptying and therefore reduce the absorption rate of diazepam.

Significance
ALL BENZODIAZEPINES: While concomitant use of opioids and benzodiazepines may be clinically appropriate in some situations, it is important to monitor the patient for excessive CNS and/or respiratory depression.

It is important to warn patients of the potential for a reduction in psychomotor function when these drugs are taken concurrently. They may or may not be aware of their deterioration in skill level and response will vary between individuals. They will likely experience a deterioration in their abilities to operate a vehicle and/or carry out tasks that require mental alertness.

Non-medical use of benzodiazepines with methadone is associated with higher hospitalization rates, greater ICU utilization rates and considerably worse medical outcomes when compared to non-medical use of benzodiazepines with buprenorphine.

Benzodiazepines may decrease opioid requirements, although there is conflicting information.

DIAZEPAM: Opioids may slow the absorption of benzodiazepines.

Serious Risk for Harm

Buprenorphine and benzodiazepines are 'CNS depressants' which means they slow the brain. Mixing buprenorphine with benzodiazepines may cause dangerously slowed breathing and even death. Together they also cause sleepiness, dizziness, confusion and make it more dangerous to drive or do activities that require alertness and attention.

There are medical reports of deaths by overdose in patients who use opioids and benzodiazepines together.

Think First

Buprenorphine may slow down the absorption of benzodiazepines after you take them. This means the benzodiazepine would take longer to work and may not work as well as expected.

Think First

Doctors sometimes prescribe opioids like buprenorphine and benzodiazepines together, but this is done carefully in a medical setting with close monitoring.

References

[+]

Ahmadi J, Razeghian JL. Comparing the effect of buprenorphine and methadone in the reduction of methamphetamine craving: a randomized clinical trial. Trials 2017; 18: 259.

Bardy G, Cathala P, Eiden C, et al. An Unusual Case of Death Probably Triggered by the Association of Buprenorphine at Therapeutic Dose with Ethanol and Benzodiazepines and with Very Low Norbuprenorphine Level. J Forensic Sci 2015; 60 Suppl 1: S269-71.

Clark NC, Dietze P, Lenné MG, et al. Effect of opioid substitution therapy on alcohol metabolism. J Subst Abuse Treat 2006; 30: 191-6.

Cunningham C, Giovanniello A, Kunins H, et al. Buprenorphine Treatment Outcomes among Opioid-Dependent Cocaine Users and Non-Users. Am J Addict 2013; 22: 352-7.

Darpo B, Zhou M, Bai S, et al. Differentiating the Effect of an Opioid Agonist on Cardiac Repolarization From mu-Receptor–mediated, Indirect Effects on the QT Interval: A Randomized, 3-way Crossover Study in Healthy Subjects. Clin Ther 2016; 38: 315-26.

Harris S, Morganroth J, Ripa S, et al. Effects of buprenorphine on QT intervals in healthy subjects: results of 2 randomized positive- and placebo-controlled trials. Postgrad Med 2017; 129: 69-80.

Kao D, Haigney M, Mehler P, et al. Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration. Addiction 2015; 110: 1468-75.

Lee SC, Klein-Schwartz W, Doyon S, et al. Comparison of toxicity associated with nonmedical use of benzodiazepines with buprenorphine or methadone. Drug Alcohol Depend 2014; 138: 118-23.

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2021; July 24, 2021.

Lindsey W, Stewart D, Childress D. Drug Interactions between Common Illicit Drugs and Prescription Therapies. Am J Drug Alcohol Abuse 2012; 38: 334-43.

Lintzeris N, Mitchell TB, Bond AJ, et al. Pharmacodynamics of diazepam co-administered with methadone or buprenorphine under high-dose conditions in opioid dependent patients. Drug Alcohol Depend 2007;91:187-94.

McCance-Katz EF, Rainey PM, Moody DE. Effect of cocaine use on buprenorphine pharmacokinetics in humans. Am J Addict 2010;19:38-46.

Nasser A, Greenwald M, Vince B, et al. Sustained-Release Buprenorphine (RBP-6000) Blocks the Effects of Opioid Challenge With Hydromorphone in Subjects With Opioid Use Disorder. J Clin Psychopharmacol 2016;36:18-26.

Poole S, Pecoraro A, Subramaniam G, et al. Presence or Absence of QTc Prolongation in Buprenorphine-Naloxone Among Youth With Opioid Dependence. J Addict Med 2016;10:26-33.

Preston CL (Ed), Stockley’s Interactions Checker. [online] London: Pharmaceutical Press. (accessed on July 24, 2021).

Reynaud M, Petit G, Potard D, et al. Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction 1998; 93: 1385-92.

Stockley IH. Drug Interactions, 10th ed Online. Pharmaceutical Press 2012.

Tetrault JM, McCance-Katz EF, Moody DE, et al. The impact of recent cocaine use on plasma levels of methadone and buprenorphine in patients with and without HIV-infection. J Subst Abuse Treat 2015; 51: 70-4.

Therapeutic Research Center. Natural Medicines [Internet]. Somerville (MA): Buprenorphine; [cited July 24, 2021].

Tröster A, Ihmsen H, Singler B, et al. Interaction of fentanyl and buprenorphine in an experimental model of pain and central sensitization in human volunteers. Clin J Pain 2012; 28: 705-11.

The Drug Cocktails website – “Facts for Youth about mixing Medicine, Booze and Street Drugs” (the “Site”) has been developed as a resource for youth and staff within Children’s & Women’s Health Centre of British Columbia Branch (C&W) for Provincial Health Services Authority and its branch agencies (PHSA)(C&W and PHSA together the “Societies”). There are support systems at the Societies which may not exist in other clinical settings and therefore adoption or use of this manual is not the responsibility of the Societies. Agencies other than the Societies should use Cocktails as a guideline for reference purposes only. The contents of this website were current at the time of development in July 2013. The Societies are not responsible for information that has changed after that time, whether incorporated into the Site or not.

The Site contains best practice knowledge, but practice standards may change as more knowledge is gained. Decision making in a specific context remains the responsibility of attending professionals. Nothing on the Site should in any way be construed as being either official or unofficial policy of the Societies.

Contact information and links to websites contained on the Site are provided for convenience only. The Societies cannot guarantee that the information, links or content from these links remain current. Providing a contact or link does not mean that the Societies endorse the views, products or services that may be offered via the link. The Societies assume no responsibility or liability arising from any error in, or omission of, information or from the use of any information, link, contact, opinion, advice or similar, provided on the Site.

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buprenorphine

References

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