Bromazepam and Buprenorphine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Bromazepam
No brand names on recordBuprenorphine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Bromazepam is a benzodiazepine (a calming, sedating medicine), and buprenorphine is an opioid used for pain or for treating opioid use disorder. Both slow down your brain and your breathing. When you take them together, those effects add up. That can cause heavy drowsiness, very slow or shallow breathing, and in serious cases loss of consciousness or even death.
This does not mean you have to be afraid. It simply means these two need to be handled carefully together. Please do not stop or change either medicine on your own. Talk with your pharmacist or doctor, and get help right away if you feel unusually sleepy, confused, or your breathing feels slow.
Mechanism: additive CNS and respiratory depression from concurrent benzodiazepine (bromazepam) and opioid (buprenorphine). This is a pharmacodynamic interaction, not a metabolic one; neither is a prodrug relevant here.
Effect / evidence: increased risk of profound sedation, respiratory depression, coma, and death. Severity major, substantiation probable; epidemiologic data (Swedish MAT cohort, US 2010-2014 overdose death data) link concomitant CNS depressants with elevated mortality.
- Prefer avoiding concomitant use; taper to lowest effective dose or discontinue the benzodiazepine where feasible.
- If co-use is necessary, monitor mental status and respiratory rate; consider higher level of care.
- Do NOT withhold MAT solely due to benzodiazepine use.
What happens
An increased risk of CNS depression and respiratory depression
Interaction Deep Dive
When buprenorphine is given together with a benzodiazepine, the combined effect can produce additive CNS depression and heighten the likelihood of respiratory depression, deep sedation, coma, and death. Discontinuing benzodiazepines or other CNS depressants is favored rather than using them alongside buprenorphine. Certain situations may call for observation in a more intensive care setting or a tapering approach. In other situations, it may be suitable to slowly withdraw a patient from a prescribed benzodiazepine or other CNS depressant, or to reduce the dose to the lowest amount that remains effective. When the two must be used together, watch for respiratory depression and proceed with caution1. A Swedish epidemiological study found that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) who also took benzodiazepines or other CNS depressants (for instance, medications used for insomnia) face an elevated risk of death. Analysis of pooled nationwide death certificate data spanning 2010 to 2014 showed that most overdose deaths involving buprenorphine and methadone also involved concurrent CNS depressant use. Whether the risk of fatal overdose with concurrent CNS depressant medications varies between buprenorphine and methadone remains unknown 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Your care team can manage this safely, and both drugs may still be appropriate for you.
- Keep taking both as prescribed unless your prescriber tells you otherwise. Do not stop abruptly on your own.
- Your team may prefer to taper the benzodiazepine or use the lowest effective dose, or consider alternatives for anxiety or insomnia.
- In some cases they may monitor you more closely or in a higher level of care.
- Ask about warning signs of over-sedation and slowed breathing, and keep naloxone on hand if advised.
Raise any daytime drowsiness, confusion, or slow breathing with your pharmacist or prescriber promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) A Swedish epidemiological study reported that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, agents used to treat insomnia) have an increased risk of death. From July 1, 2005 to December 31, 2012, the risk of fatal overdose, non-overdose related mortality, and all-cause mortality was compared between periods when CNS depressants were prescribed and periods without CNS depressant therapy among MAT-prescribed patients (aged 18 to 50). The findings showed an increased risk of all-cause mortality (adjusted hazard ratio (HR) 1.44; 95% CI, 0.93 to 2.23) and non-overdose related mortality (HR 1.74; 95% CI 1.00 to 3.01) with MAT and benzodiazepine treatment; however, these data were not deemed statistically significant. Although the results indicated an increased risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods of coadministration of MAT and non-benzodiazepines, only the fatal overdose and all-cause mortality data were considered statistically significant; HR 2.34 (95% CI, 1.37 to 3.99) and HR 1.33 (95% CI, 1.12 to 2.45), respectively. A comparison between the benzodiazepine cohort and the non-benzodiazepine cohort was not performed because the authors did not adjust for the indication of use for the drugs 3.
b) Based on a study of aggregate nationwide death certificate data from 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were commonly cited as contributors to those deaths. Concurrent alprazolam use was reported in 18.1% of cases, followed by oxycodone (10.1%), cocaine (9.6%), heroin (9%), and diazepam (6.6%). The FDA reported 322 drug overdose deaths in 2014 involving buprenorphine. Of these 322 deaths, 32.9% involved alprazolam, 17.4% involved clonazepam, 11.2% involved diazepam, 11.2% involved heroin, and 9.9% involved fentanyl. The absolute number of methadone-involved deaths was 10 times the number of buprenorphine-involved deaths, although confounding factors and differences in drug utilization were not taken into account. It remains unknown whether the risk of overdose death with concomitant CNS depressant drugs differed between buprenorphine and methadone 3.
Common questions
Can I take Bromazepam and Buprenorphine together?
Combining bromazepam with buprenorphine adds up their sedating effects and can dangerously slow breathing, so use both only under close medical supervision and never adjust either on your own. Seek help right away for extreme drowsiness or slow breathing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Bromazepam and Buprenorphine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Bromazepam and Buprenorphine interaction managed?
Your care team can manage this safely, and both drugs may still be appropriate for you. Keep taking both as prescribed unless your prescriber tells you otherwise. Do not stop abruptly on your own. Your team may prefer to taper the benzodiazepine or use the lowest effective dose, or consider alternatives for anxiety or insomnia. In some cases they may monitor you more closely or in a higher level o… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Bromazepam or Buprenorphine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
- Product Information: SUBUTEX(R) sublingual tablets, buprenorphine sublingual tablets. Indivior Inc (per FDA), North Chesterfield, VA, 2021. DailyMed
- US Food and Drug Administration (FDA): Drug Safety Communications: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks. US Food and Drug Administration (FDA). Silver Spring, MD. 2017.
Keep reading about Bromazepam
Keep reading about Buprenorphine
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