Buprenorphine and Gabapentin: 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
Gabapentin
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 slow you down. Buprenorphine is a strong opioid, and gabapentin can cause drowsiness too. When you take them together, those calming effects can add up. That can lead to heavy sedation and, in some cases, slowed or shallow breathing, which is serious.
This does not mean you can't take both. Many people safely use them together when their care team keeps an eye on things. Please don't stop or change either one on your own. Instead, talk with your pharmacist or doctor so they can find the lowest doses that work for you and watch you more closely. Get help right away if you feel very sleepy, confused, or short of breath.
Mechanism: Additive CNS depression. Buprenorphine (partial mu-opioid agonist) plus gabapentin (CNS depressant) produce combined sedation and respiratory depression. This is a pharmacodynamic interaction, not a metabolic/prodrug one.
Direction/effect: Increased risk of profound sedation, respiratory depression, coma, and death.
- Severity: Major; evidence: probable; onset: unspecified.
- Management: Do not withhold MAT. Use lowest effective gabapentin dose or taper where clinically appropriate; consider alternatives for anxiety/insomnia. Monitor for respiratory depression and oversedation, escalating level of care if needed.
What happens
An increased risk of respiratory depression and CNS depression
Interaction Deep Dive
When buprenorphine is given together with a CNS depressant, the combined effect on the central nervous system may be additive, raising the likelihood of respiratory depression, profound sedation, coma, and death. Discontinuing the CNS depressant is favored rather than using both agents at the same time. Depending on the situation, it may be suitable to observe the patient in a higher level of care or to implement a taper. In other circumstances, slowly weaning a patient from a prescribed CNS depressant, or reducing it to the smallest dose that remains effective, may be appropriate. Should combined use be required, exercise careful monitoring and management, and weigh alternative treatments for anxiety or insomnia2. A Swedish epidemiological study found that patients on methadone- or buprenorphine-based medication-assisted treatment (MAT) who also received benzodiazepines or other CNS depressants (for example, medications used for insomnia) have a heightened risk of death. Based on an analysis of pooled nationwide death certificate data covering 2010 to 2014, most overdose deaths involving buprenorphine and methadone also involved the concurrent use of a CNS depressant. Whether the overdose death risk associated with concomitant CNS depressant drugs varied between buprenorphine and methadone is not known 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. Your buprenorphine treatment should not be stopped just because you also take gabapentin.
- Your team may use the lowest effective dose of gabapentin, or gradually taper it if that fits your situation.
- They may monitor you more closely for excessive sleepiness or slowed breathing.
- If gabapentin is for anxiety or sleep, ask whether an alternative is an option.
Get emergency help if you or someone notices extreme drowsiness, confusion, or slow/shallow breathing. Bring this up at your next pharmacist or prescriber visit.
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 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 increased risk of death. From July 1, 2005 to December 31, 2012, investigators compared the risk of fatal overdose, non-overdose related mortality, and all-cause mortality during periods when CNS depressants were prescribed versus periods without CNS depressant therapy in MAT 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 MAT plus benzodiazepine treatment; however, these data were not deemed statistically significant. Although results indicated a raised 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 regarded as statistically significant; HR 2.34 (95% CI, 1.37 to 3.99) and HR 1.33 (95% CI, 1.12 to 2.45), respectively. No comparison between the benzodiazepine cohort and the non-benzodiazepine cohort was performed because the authors did not adjust for the indication of use of the drugs 3.
b) According to 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. Concurrent 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 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 number of methadone-involved deaths was 10 times the number 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 not known 3.
Common questions
Can I take Buprenorphine and Gabapentin together?
Buprenorphine and gabapentin together can add up to dangerous sedation and slowed breathing, so use them only under your care team's guidance at the lowest effective doses, and seek help for extreme drowsiness or breathing trouble. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Gabapentin 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 Gabapentin interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. Your buprenorphine treatment should not be stopped just because you also take gabapentin. Your team may use the lowest effective dose of gabapentin, or gradually taper it if that fits your situation. They may monitor you more closely for excessive sleepiness or slowed breathing. If gabapentin is for anxiety or sleep,… 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 Gabapentin 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 Gabapentin
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