Buprenorphine and Arsenic Trioxide: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buprenorphine
Arsenic Trioxide
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 buprenorphine (a pain and addiction medicine) and arsenic trioxide (used to treat a type of leukemia) can affect your heart's electrical rhythm. Doctors call this QT prolongation. When two medicines that do this are taken together, the effect can add up and, in rare cases, lead to a dangerous heartbeat.
Right now this is mostly a theoretical concern for buprenorphine, meaning it hasn't been well studied in this exact combination. The good news is your care team knows how to watch for this. Please don't stop either medicine on your own. Just talk with your doctor or pharmacist so they can keep an eye on your heart and any risk factors.
Additive QT prolongation. Both agents independently prolong the QT interval, so concurrent use raises the theoretical risk of QTc prolongation and torsades de pointes. Neither is a prodrug; this is a pharmacodynamic (additive), not metabolic, interaction.
- Direction: increased combined QT effect.
- Evidence: theoretical; magnitude with buprenorphine specifically is not established.
- Onset: unspecified.
- Management: Manufacturer advises avoiding concomitant use. If unavoidable, obtain baseline and follow-up ECGs, correct electrolytes (K+, Mg2+), and reassess risk factors (bradycardia, CHF, baseline QT prolongation, congenital long-QT, digitalis therapy, recent AF conversion).
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
The simultaneous administration of buprenorphine alongside medications capable of extending the QT interval should be avoided123. It remains unknown what risk arises when buprenorphine is combined with other agents that prolong QT prolongation. When prescribing buprenorphine to patients who present 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, clinicians should factor these considerations into their decisions4.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Your care team manages this by weighing whether both drugs are truly needed and by watching your heart closely if they are used together.
- Keep taking both as prescribed unless your doctor tells you otherwise.
- Your team may check an ECG and blood tests for potassium and magnesium, since low levels raise the risk.
- Tell your prescriber about heart problems, a slow heartbeat, or a family history of rhythm disorders.
- Report fainting, dizziness, or a fluttering or pounding heartbeat right away.
Ask your pharmacist or doctor whether an alternative to one of these medicines may be an option for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Buprenorphine and Arsenic Trioxide together?
Combining buprenorphine and arsenic trioxide can add together their effects on your heart's rhythm, so your care team may avoid the combination or monitor your ECG and electrolytes closely. Keep taking both as prescribed and report any fainting or irregular heartbeat. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Arsenic Trioxide 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 Arsenic Trioxide interaction managed?
Your care team manages this by weighing whether both drugs are truly needed and by watching your heart closely if they are used together. Keep taking both as prescribed unless your doctor tells you otherwise. Your team may check an ECG and blood tests for potassium and magnesium, since low levels raise the risk. Tell your prescriber about heart problems, a slow heartbeat, or a family history of rh… 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 Arsenic Trioxide 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: 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
- Product Information: BUTRANS(R) transdermal system patch, buprenorphine transdermal system patch. Purdue Pharma L.P. (per FDA), Stamford, CT, 2016. DailyMed
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
Keep reading about Buprenorphine
Keep reading about Arsenic Trioxide
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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