Suboxone and Medications: What Not to Take Together

Suboxone is used in opioid addiction treatment to manage drug cravings and reduce withdrawal symptoms. It contains two active medications: buprenorphine, which alleviates cravings and withdrawal by activating the same receptors that opioid drugs occupy, and naloxone, which causes withdrawal symptoms if a person misuses Suboxone.

While Suboxone is beneficial for those in opioid addiction treatment, there are some Suboxone drug interactions, meaning that certain medications may not be safe to take while on Suboxone. Sometimes, interactions can be severe, so it is important to know the answer to, “What medications can you not take with Suboxone?

Can Suboxone Be Taken With Other Medications?

Some medications can be taken with Suboxone, whereas others cannot. If you have questions about Suboxone interactions with specific medications you are taking, it is important to consult with your Suboxone doctor. 

There are many medications that can be safely taken with Suboxone, but others can cause interaction effects, which can range from mild to severe. 

Suboxone Drug Interactions 

The first part of understanding which medications cannot be taken with Suboxone is learning about what medications interact with this drug. The Food and Drug Administration (FDA) warns of several classes of medications that can cause Suboxone interactions:

• Benzodiazepines: This class of drugs is used to treat anxiety, and they have a sedative effect. Some people may take benzodiazepines to treat seizures. 

• Central Nervous System Depressants: Benzodiazepine drugs are often classified as central nervous system (CNS) depressants, as they slow brain activity, like other CNS depressants. Also in this class of drugs are sleep medications and barbiturates. 

• CYP3A4 Inhibitors and Inducers:  CYP3A4 is an enzyme that plays an important role in drug metabolism, and certain drugs can affect the activity of this enzyme and make other medications less effective. 

• Antiretrovirals: This class of medications is used to manage HIV and is known to cause Suboxone interactions. 

• Serotonergic Drugs: These include medications called SSRIs, which are commonly used to treat depression. 

The list above is not comprehensive, but it provides a general overview of what not to take with Suboxone. It is always recommended to speak to your provider about possible drug interactions if you take more than one medication.  

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What Medications Can You Not Take With Suboxone?

There are some general classes of drugs that should not be taken in combination with Suboxone, but it’s also helpful to know specific medications that can interact with it. 

The list below provides examples of what not to take with Suboxone. While it does cover the drugs that most commonly cause Suboxone interaction effects, it is not comprehensive.

 If you’re taking a medication on this list, it’s important to consult with your doctor to determine if it is safe to take the medication while on Suboxone. 

Erythromycin 

This antibiotic medication acts as a CYP3A4 inhibitor, and it can increase levels of buprenorphine in the body. 

What Happens When Suboxone Is Mixed With Erythromycin? 

Erythromycin acts as a CYP3A4 inhibitor, and as such, it can increase levels of buprenorphine and enhance the opioid effects of Suboxone. This enhances the side effects associated with the medication. In some cases, mixing the two medications can increase sedation or cause respiratory depression. 

Gabapentin

Gabapentin is an anticonvulsant drug used to treat seizures. Some people may take this medication to treat restless leg syndrome and diabetic nerve damage. 

What Happens When You Mix Suboxone and Gabapentin?

Both Suboxone and gabapentin act as central nervous system depressants, meaning that they can interact with each other. When Suboxone is taken with gabapentin, interaction effects can lead to breathing problems, coma, and even death.

Ativan

Ativan belongs to the benzodiazepine class of drugs, and it is used to treat anxiety. Sometimes it is known by its generic name, lorazepam.

Consequences of Mixing Ativan and Suboxone

When taken together, Ativan and Suboxone can cause extreme sedation, as well as respiratory depression, coma, and death. Given the risk of a severe Suboxone and Ativan interaction, these two medications generally should not be taken together. 

Other benzodiazepine drugs that can cause Suboxone interactions include Valium, Xanax, Halcion, and Klonopin. 

Hydrocodone

Opioid drugs like hydrocodone and oxycodone are used to treat pain, and they are also commonly misused, given their sedative effects and ability to create feelings of euphoria. 

What Happens When You Mix Suboxone and Hydrocodone? 

Since both buprenorphine and hydrocodone have opioid effects, taking them together intensifies the side effects of both medications and increases the risk of an opioid overdose. 

Zoloft 

Zoloft is an antidepressant medication that belongs to a class of drugs called SSRIs. 

Dangers of Mixing Suboxone and Zoloft

The combination of Suboxone with Zoloft or other medications in the SSRI class increases the risk of serotonin syndrome, which occurs when serotonin levels are too high. Symptoms of this condition include confusion, hallucinations, seizures, elevated heart rate, fever, sweating, nausea, vomiting, and tremor. In some cases, serotonin syndrome can cause coma or death.

Based on the potential for serotonin syndrome, Zoloft is listed as having moderate Suboxone interactions. Other medications in the SSRI class, including Lexapro and Prozac, can also interact with Suboxone. Cymbalta, an antidepressant medication belonging to a slightly different class called SNRIs, can also cause serotonin syndrome. 

Ketoconazole

This antifungal medication is known to be a CYP3A4 inhibitor. 

What Happens When You Mix Ketoconazole with Suboxone?

As a CYP3A4 inhibitor, ketoconazole can increase buprenorphine levels and can enhance Suboxone side effects, like drowsiness, confusion, and respiratory distress. Severe interactions can result in coma and death. 

Efavirenz

Efavirenz belongs to the antiretroviral class of medications, which are used to manage HIV symptoms.

The Risks Of Mixing Efavirenz And Suboxone

Efavirenz and other medications in its class have been shown to have Suboxone interactions. Some patients experience increased sedation when combining Suboxone with efavirenz and other antiretroviral drugs. Other medications in this class include nevirapine, etravirine, delavirdine, atazanavir, and ritonavir. 

Phenelzine 

Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. 

What Happens When You Mix Phenelzine and Suboxone? 

Phenelzine and other MAOI drugs can cause Suboxone interactions and lead to serotonin syndrome. Other MAOIs that should be avoided with Suboxone include selegiline and isocarboxazid. Severe interactions between Suboxone and MAOIs include respiratory depression and coma.

Lyrica

Lyrica, also known by its generic name, pregabalin, is used in the treatment of fibromyalgia and nerve pain. 

Risks Of Mixing Lyrica And Suboxone

Lyrica can cause Suboxone drug interactions because it is a central nervous system depressant and can increase side effects, such as respiratory distress, and lead to coma or death. It is known to have a major interaction with Suboxone.

Seroquel 

Seroquel is a psychotropic medication used in the treatment of depression, bipolar disorder, and schizophrenia. 

What Happens When You Mix Seroquel With Suboxone?

Seroquel is labeled as having a moderate Suboxone interaction, because it increases the risk of developing an irregular heart rhythm. This risk is greater among people who have pre existing heart conditions. 

Vyvanse

Vyvanse is a stimulant medication used in the treatment of ADHD. It is sometimes used to treat binge eating disorder as well. 

Risks of Mixing Suboxone With Vyvanse

Suboxone and Vyvanse can cause an irregular heart rhythm when taken together, especially in people with heart conditions. 

Trazodone 

Trazodone belongs to a class of drugs called serotonin modulators, and it is used to treat depression. 

What Happens When Trazodone And Suboxone Are Mixed?

Trazodone and Suboxone can interact and increase the risk of irregular heart rhythm, especially in people who have pre existing heart conditions. 

Lisinopril 

Also on the list of what not to take with Suboxone is lisinopril, a medication that is used to treat high blood pressure.

What Happens When You Take Suboxone And Lisinopril Together? 

Since both medications can lower blood pressure levels, when Suboxone and lisinopril are taken together, they can cause dangerous drops in blood pressure and lead to headaches, dizziness, and fainting. These risks are higher with dose increases or when first starting to take these medications. 

Ambien

Ambien, also known by the generic name zolpidem, is a prescription medication used to treat insomnia.

What Are The Dangers Of Mixing Suboxone With Ambien?

Ambien and Suboxone are known to have a major interaction effect. When taken together, the two drugs can cause increased risk of respiratory distress, coma, and death, because both are central nervous system depressants. 

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Other FAQs

If you’re seeking additional information about what not to take with Suboxone, the answers to the following FAQs can be helpful. 

Can I Take Muscle Relaxers With Suboxone?

Muscle relaxants generally should not be taken with Suboxone, because they can increase the risk of respiratory depression. If you are required to take a muscle relaxer while on Suboxone, consult with your doctor about minimizing your risks. You may also need to reduce your dose of either medication to decrease Suboxone interaction effects. 

Can You Take Cold Medicine While On Suboxone?

It is important to consult with your doctor prior to taking a cold medication while on Suboxone. Cough medication like Mucinex, which contains the active ingredient guaifenesin, is not known to have Suboxone interactions, but many other cold medications contain ingredients like diphenhydramine, which causes drowsiness and can interact with Suboxone.

Can You Take Lorazepam With Suboxone?

Lorazepam is a benzodiazepine drug, and it should not be taken with Suboxone. Benzodiazepines like lorazepam can increase the sedative effects of Suboxone and lead to respiratory depression, coma, and death.

What Pain Medication Can You Take With Suboxone?

Opioid pain medications like oxycodone and hydrocodone should be avoided while taking Suboxone. Over-the-counter pain medications like ibuprofen and aspirin are generally safe while taking Suboxone, but you should always ask your doctor about potential interaction effects. 

What Antidepressant Can I Take With Suboxone?

Several antidepressant drugs are known to cause Suboxone interactions. These include SSRIs, monoamine oxidase inhibitors, and a medication called Buspirone. Talk with a doctor about the best antidepressant with Suboxone. 

What Anxiety Medication Is Safe With Suboxone?

If you live with anxiety but take Suboxone, it is important to consult with your doctor before starting anxiety medication. Many medications commonly used to treat anxiety can cause Suboxone interactions. 

A doctor can determine the best medication for treating anxiety while on Suboxone. Given the potential for interactions between Suboxone and anxiety medications, a doctor will carefully monitor you for side effects. In some cases, they may recommend therapy for anxiety before starting medication. 

Do Antibiotics Interact With Suboxone?

Certain antibiotics like erythromycin have Suboxone drug interactions, but others, like amoxicillin, do not. If you need an antibiotic, be sure to tell your doctor that you are also taking Suboxone, and they can choose an antibiotic that has the lowest risk of causing interaction effects. 

Can You Take Ibuprofen While On Suboxone? 

There are no known interaction effects between ibuprofen and Suboxone, but every person will react differently to medication interactions. Be sure to check with your doctor to ensure if it is safe to take ibuprofen while on Suboxone. 

Access A Suboxone Doctor From Home Through Confidant Health 

If you have questions about Suboxone, such as what medications not to take with Suboxone, our online Suboxone clinic can provide you with answers from the privacy of home. Download Confidant’s app today on either the Apple Store or the Google Play Store to access virtual opioid addiction treatment.

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