Buprenorphine and Indinavir: 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
Indinavir
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.
Here's what's going on. Your body uses a liver enzyme called CYP3A4 to break down buprenorphine (Belbuca, Suboxone, and others). Indinavir slows that enzyme down. So while you take both, buprenorphine can build up in your blood and act stronger than usual.
That matters because buprenorphine is an opioid. Too much can cause heavy drowsiness, confusion, and slowed breathing. The good news is your care team can handle this by adjusting your buprenorphine dose and watching you more closely. Please don't start, stop, or change either medicine on your own. If you feel unusually sleepy or short of breath, get help right away and let your pharmacist or doctor know.
Mechanism: Indinavir is a potent CYP3A4 inhibitor. Buprenorphine is CYP3A4-metabolized (not a prodrug), so inhibition reduces its clearance and increases plasma exposure (AUC/Cmax).
Direction/effect: Increased buprenorphine exposure, raising risk of sedation and respiratory depression. Severity major; evidence probable; onset unspecified.
Management:
- If starting indinavir, consider reducing the buprenorphine dose until stable; monitor frequently for sedation/respiratory depression.
- On indinavir discontinuation, consider a buprenorphine dose increase and monitor for withdrawal.
- For long-acting subQ formulations that limit precise titration, watch for over-medication; transition to a titratable formulation if adjustment is needed.
What happens
Increased buprenorphine exposure and an increased risk of buprenorphine-related adverse events
Interaction Deep Dive
Combining buprenorphine with a CYP3A4 inhibitor can raise buprenorphine plasma levels, potentially leading to extended opioid effects such as respiratory depression. When a patient on buprenorphine must also receive a CYP3A4 inhibitor, consider lowering the buprenorphine dose until stable drug effects are reached, and check often for sedation and respiratory depression. Conversely, when the CYP3A4 inhibitor is stopped in a patient maintained on buprenorphine, consider raising the buprenorphine dose until stable drug effects are attained while watching for indications of opioid withdrawal2. If dosing cannot be modified once the CYP3A4 inhibitor is no longer present, switch the patient back to a buprenorphine formulation that allows more precise dose titration. For patients being converted from transmucosal buprenorphine taken together with CYP3A4 inhibitors, confirm through monitoring that the buprenorphine plasma level achieved with subQ buprenorphine is sufficient. For those already receiving subQ buprenorphine who then need a CYP3A4 inhibitor, watch for indications of over-medication. Should signs and symptoms of buprenorphine toxicity or overdose develop while the concomitant medication cannot be reduced or discontinued, lower the buprenorphine dose. If the available doses do not allow the target dose to be reached, stop treatment and manage the patient with a buprenorphine formulation that permits more precise dose adjustments1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of buprenorphine
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. This combination is manageable with the right adjustments.
- Your team may lower your buprenorphine dose while you are on indinavir, and monitor you more closely for drowsiness or slowed breathing.
- When indinavir is stopped, your buprenorphine dose may need to go back up, with watching for withdrawal symptoms.
- Your dose may need to be adjusted and individualized. If you use a long-acting shot form, your team may switch to a form that allows more precise dosing.
Tell your pharmacist or prescriber before any changes, and seek help right away for extreme sleepiness or trouble breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The impact of concurrently administered CYP3A4 inhibitors on buprenorphine exposure in patients receiving subQ buprenorphine has not been investigated; nevertheless, these interactions have been demonstrated in studies employing transmucosal buprenorphine. The effects of buprenorphine may depend on the route by which it is administered 1.
Common questions
Can I take Buprenorphine and Indinavir together?
Indinavir can raise buprenorphine levels and increase the risk of over-sedation and slowed breathing, so your care team may lower your buprenorphine dose and monitor you more closely. Do not change either medication on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Indinavir 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 Indinavir interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. This combination is manageable with the right adjustments. Your team may lower your buprenorphine dose while you are on indinavir, and monitor you more closely for drowsiness or slowed breathing. When indinavir is stopped, your buprenorphine dose may need to go back up, with watching for withdrawal symptoms. Your d… 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 Indinavir 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
- Product Information: ZUBSOLV(R) sublingual tablets, buprenorphine naloxone sublingual tablets. Orexo US Inc (per FDA), Morristown, NJ, 2023. DailyMed
Keep reading about Buprenorphine
Keep reading about Indinavir
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