Buprenorphine and Ethchlorvynol: 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
Ethchlorvynol
No brand names on record
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.
These two medicines can slow you down too much when taken together. Buprenorphine is an opioid used for pain or to treat opioid use disorder. Ethchlorvynol is an older sedative used for sleep. Both calm the brain and slow breathing, so combining them can add up. That can lead to heavy drowsiness, very slow or shallow breathing, and in serious cases, unresponsiveness.
The good news is your care team can manage this. Please don't stop either medicine on your own. Talk with your pharmacist or doctor so they can decide the safest plan for you, which may mean adjusting a dose or watching you more closely.
Effect: Additive CNS and respiratory depression with concomitant buprenorphine and ethchlorvynol (a sedative-hypnotic CNS depressant).
- Mechanism: Pharmacodynamic (additive CNS depression); neither is a prodrug, so effect is direct summation, not enzyme-mediated.
- Direction/risk: Increased sedation, respiratory depression, profound sedation, coma, death.
- Evidence: Probable; severity major; onset unspecified. Epidemiologic data link MAT plus CNS depressants to increased overdose death.
- Management: Prefer discontinuation/taper of the CNS depressant or lowest effective dose; consider alternatives for insomnia. If co-used, monitor respiratory status, consider higher level of care. Do not withhold MAT.
What happens
An increased risk of respiratory depression and CNS depression
Interaction Deep Dive
When buprenorphine is given together with a CNS depressant, the effects on the CNS may combine, raising the likelihood of respiratory depression, deep sedation, coma, and death. Discontinuing the CNS depressant is favored rather than using both agents at once. Monitoring within a higher level of care or a taper may be suitable in certain situations. In other situations, it may be appropriate to slowly wean a patient from a prescribed CNS depressant or to reduce it to the smallest effective dose. When both must be used together, exercise caution in monitoring and management; alternative treatments for insomnia or anxiety should be considered2. A Swedish epidemiological investigation found that patients on methadone- or buprenorphine-based medication-assisted treatment (MAT) who also took benzodiazepines or other CNS depressants (for example, medications used for insomnia) had an elevated risk of death. Based on an analysis of combined nationwide death certificate data spanning 2010 to 2014, most overdose deaths involving buprenorphine and methadone also involved concurrent CNS depressant use. Whether this risk of overdose death with concurrent CNS depressants varied between buprenorphine and methadone remains unknown 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
What your care team may do:
- Prefer stopping or slowly tapering the sedative (ethchlorvynol) rather than using both together, or lowering it to the smallest dose that works.
- Consider a different, safer option for sleep or anxiety.
- Monitor you more closely for slowed breathing and heavy sedation, sometimes in a higher level of care.
What you should do: Keep taking both exactly as prescribed until you speak with your prescriber or pharmacist. Do not stop your buprenorphine on your own. Ask about the safest plan, and get emergency help for extreme drowsiness, confusion, or very slow breathing.
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. Between July 1, 2005 and December 31, 2012, investigators examined the risk of fatal overdose, non-overdose related mortality, and all-cause mortality in MAT-prescribed patients (aged 18 to 50), comparing periods when CNS depressants were prescribed to periods without CNS depressant therapy. 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 MAT plus benzodiazepine treatment, but these results were not deemed statistically significant. Although the results indicated an increased risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods when MAT and non-benzodiazepines were given together, 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 3.
b) Based on a study of pooled nationwide death certificate data from 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were often listed as contributors to those deaths. Simultaneous ALPRAZolam use was noted in 18.1% of cases, followed by oxyCODONE (10.1%), cocaine (9.6%), heroin (9%), and diazePAM (6.6%). The FDA documented 322 drug overdose deaths in 2014 that involved 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 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. Whether the risk of overdose death with concurrent CNS depressant drugs differed between buprenorphine and methadone is not known 3.
Common questions
Can I take Buprenorphine and Ethchlorvynol together?
Combining buprenorphine with the sedative ethchlorvynol can dangerously slow breathing and sedation, so contact your prescriber or pharmacist to review the safest plan rather than stopping anything yourself. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Ethchlorvynol 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 Ethchlorvynol interaction managed?
What your care team may do: Prefer stopping or slowly tapering the sedative (ethchlorvynol) rather than using both together, or lowering it to the smallest dose that works. Consider a different, safer option for sleep or anxiety. Monitor you more closely for slowed breathing and heavy sedation, sometimes in a higher level of care. What you should do: Keep taking both exactly as prescribed until yo… 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 Buprenorphine or Ethchlorvynol 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 Buprenorphine
Keep reading about Ethchlorvynol
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist