Buprenorphine and Baclofen: 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
Baclofen
Buprenorphine
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.
Baclofen is a muscle relaxer, and buprenorphine is an opioid medicine (used for pain or to treat opioid use disorder). Both can slow down your brain and your breathing. When you take them together, that calming effect can add up, so you might feel very sleepy, dizzy, or foggy, and in serious cases your breathing can slow down too much.
The good news is your care team can manage this. They may adjust your baclofen dose and watch you a bit more closely, and they might give you a naloxone rescue kit just in case. Please don't stop either medicine on your own. Instead, talk with your pharmacist or doctor about how you're feeling.
Mechanism: additive CNS and respiratory depression. Baclofen (GABA-B agonist) and buprenorphine (partial mu-opioid agonist) both depress the CNS; the combination may enhance neuromuscular blockade and respiratory depression. This is a pharmacodynamic interaction, not CYP-mediated; neither agent's clearance drives the effect.
- Direction: increased sedation/respiratory depression (additive)
- Severity/evidence: major; probable
- Onset: unspecified
- Management: monitor for greater-than-expected respiratory depression and sedation; reduce muscle relaxant dose as needed; consider prescribing naloxone. Do not withhold MAT (buprenorphine) solely due to CNS depressant use, given the mortality risk of untreated OUD.
What happens
Enhanced neuromuscular blocking action and an increased risk of respiratory depression and CNS depression
Interaction Deep Dive
When buprenorphine is given together with skeletal muscle relaxants, the neuromuscular blocking effect of the muscle relaxants may be intensified, and a greater degree of respiratory depression may result. Watch patients who are taking both a muscle relaxant and buprenorphine for indications of respiratory depression that could exceed what would normally be anticipated, reduce the muscle relaxant dose when needed, and consider prescribing naloxone for emergency management of opioid overdose1. A Swedish epidemiological study found that mortality risk is raised in patients on methadone- or buprenorphine-based medication-assisted treatment (MAT) who also use benzodiazepines or other CNS depressants (for instance, agents used to treat insomnia). Based on an analysis of aggregate nationwide death certificate data spanning 2010 to 2014, most overdose deaths involving buprenorphine and methadone also involved the concurrent use of a CNS depressant. Whether the risk of overdose death from concomitant CNS depressant drugs varied between buprenorphine and methadone is not known2.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Your care team can manage this combination safely. Typically they will:
- Watch you more closely for signs of too much sedation or slowed breathing, especially early on.
- Adjust the baclofen dose as needed, individualized to you.
- Consider prescribing naloxone (an opioid rescue medicine) to keep on hand.
Keep taking both medicines exactly as prescribed unless told otherwise. If buprenorphine is treating opioid use disorder, it should not be stopped just because you also take a muscle relaxer. Tell your pharmacist or prescriber right away if you feel unusually drowsy, confused, or short of breath. Make sure someone close to you knows how to use naloxone.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) A Swedish epidemiological study found that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, medications used for insomnia) have an increased risk of death. From July 1, 2005 through December 31, 2012, investigators examined the risk of fatal overdose, non-overdose related mortality, and all-cause mortality by comparing periods when CNS depressants were prescribed to periods without CNS depressant therapy among MAT-treated patients (aged 18 to 50). The findings showed a raised 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 concurrent MAT and benzodiazepine treatment; however, these data were not deemed statistically significant. Although results indicated a higher risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods when MAT and non-benzodiazepines were coadministered, only the fatal overdose and all-cause mortality data reached statistical significance; HR 2.34 (95% CI, 1.37 to 3.99) and HR 1.33 (95% CI, 1.12 to 2.45), respectively. The authors did not compare the benzodiazepine cohort with the non-benzodiazepine cohort because they did not adjust for the indication of use for the drugs 2.
b) Based on aggregate nationwide death certificate data spanning 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were commonly cited as contributors to those deaths. Alprazolam was used concurrently 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. Among 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 count of methadone-involved deaths was 10 times that of buprenorphine-involved deaths, though confounding factors and differences in drug utilization were not taken into account. Whether the risk of overdose death with concomitant CNS depressant drugs differed between buprenorphine and methadone is unknown 2.
Common questions
Can I take Buprenorphine and Baclofen together?
Baclofen and buprenorphine both slow the brain and breathing, so together they raise the risk of heavy sedation and dangerously slow breathing. Keep taking both as prescribed, ask about a naloxone kit, and report any severe drowsiness or breathing trouble to your care team. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Baclofen 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 Baclofen interaction managed?
Your care team can manage this combination safely. Typically they will: Watch you more closely for signs of too much sedation or slowed breathing, especially early on. Adjust the baclofen dose as needed, individualized to you. Consider prescribing naloxone (an opioid rescue medicine) to keep on hand. Keep taking both medicines exactly as prescribed unless told otherwise. If buprenorphine is treati… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Buprenorphine or Baclofen 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 (2)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. 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 Baclofen
Keep reading about Buprenorphine
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