Buprenorphine and Apomorphine: 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
Buprenorphine
Apomorphine
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.
Both of these medicines can affect your heart's rhythm. Buprenorphine (a pain or addiction medicine) and apomorphine (used for Parkinson's) can each stretch out a part of your heartbeat called the QT interval. When two medicines that do this are taken together, that effect can add up and, in rare cases, lead to a dangerous irregular heartbeat.
Please don't stop either medicine on your own. This concern is based on how the drugs work rather than lots of real-world reports, so the true risk isn't fully measured. Your care team can manage it, sometimes by choosing a different option or by keeping a closer eye on your heart. Just let your pharmacist or doctor know you take both.
Additive QT prolongation. Both buprenorphine and apomorphine independently carry QT-prolonging potential; concurrent use theoretically increases risk of QTc prolongation and torsades de pointes. Neither agent's effect here depends on prodrug activation, so this is a straightforward pharmacodynamic (additive) interaction, not a metabolic one.
- Direction: increased combined QT effect
- Onset: unspecified
- Evidence: theoretical; magnitude of combined risk not quantified
- Management: avoid concomitant use where possible. If combined, correct electrolytes (K+, Mg2+), obtain baseline and follow-up ECGs, and use caution with risk factors: hypokalemia, bradycardia, recent AF conversion, CHF, digitalis therapy, baseline/subclinical long-QT, severe hypomagnesemia.
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
The simultaneous administration of buprenorphine alongside agents capable of prolonging the QT interval should be avoided342. It remains unknown what risk arises from pairing buprenorphine with other QT prolongation drugs. When buprenorphine is prescribed to patients presenting with risk factors, including hypokalemia, bradycardia, recent conversion from atrial fibrillation, congestive heart failure, digitalis therapy, baseline QT prolongation, subclinical long-QT syndrome, or severe hypomagnesemia, these observations should be factored into clinical decisions1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
The goal is to protect your heart rhythm. Because both drugs can prolong the QT interval, your care team will often prefer to avoid using them together when there is another option.
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Your team may check an ECG and blood levels of potassium and magnesium, and monitor you more closely.
- Tell your prescriber if you have heart failure, a slow or irregular heartbeat, a known long-QT problem, or take digoxin.
- Report fainting, dizziness, or a fluttering or pounding heartbeat right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Buprenorphine and Apomorphine together?
Combining buprenorphine and apomorphine may add together their effects on your heart rhythm (QT prolongation), so avoid using them together when possible and let your care team decide; they can monitor your heart and correct electrolytes if both are needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Apomorphine 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 Buprenorphine and Apomorphine interaction managed?
The goal is to protect your heart rhythm. Because both drugs can prolong the QT interval, your care team will often prefer to avoid using them together when there is another option. Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Your team may check an ECG and blood levels of potassium and magnesium, and monitor you more closely. Tell your prescriber if you have… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Buprenorphine or Apomorphine 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 (4)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
- Product Information: BUTRANS(R) transdermal system patch, buprenorphine transdermal system patch. Purdue Pharma L.P. (per FDA), Stamford, CT, 2016. DailyMed
- Product Information: BELBUCA(TM) buccal film, buprenorphine buccal film. Endo Pharmaceuticals Inc. (per FDA), Malvern, PA, 2016.
- Product Information: BUPRENEX(R) intravenous injection, intramuscular injection, buprenorphine HCl intravenous injection, intramuscular injection. Indivior Inc. (per DailyMed), Richmond, VA, 2016. DailyMed
Keep reading about Buprenorphine
Keep reading about Apomorphine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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