Buprenorphine and Meclizine: 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
Meclizine
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.
Buprenorphine (Belbuca, Suboxone, and others) is an opioid, and meclizine (Antivert, Bonine, Dramamine) is used for dizziness and nausea. Both can make you sleepy and slow your breathing, so taking them together can add up to too much drowsiness or dangerously slow breathing. Meclizine also has drying (anticholinergic) effects, so together they can worsen constipation and make it hard to pee, which in rare cases can cause the gut to stop moving.
The good news is your care team can manage this. Watch for heavy sedation, slow breathing, bad constipation, or trouble urinating, and reach out to your pharmacist or doctor before changing anything.
Effect: Additive CNS and respiratory depression plus additive anticholinergic/opioid effects on GI and bladder motility (risk of urinary retention, severe constipation, paralytic ileus).
Mechanism: Pharmacodynamic (additive), not PK. Neither agent is metabolism-dependent for this interaction. Both contribute sedation; meclizine adds anticholinergic burden compounding opioid-induced constipation.
- Direction: Increased combined sedative/respiratory and GI effects.
- Evidence: Probable; severity major. Onset unspecified.
- Management: Use lowest effective doses; monitor for sedation, respiratory depression, urinary retention, constipation. Consider non-sedating alternatives for nausea/vertigo. Do not withhold MAT.
What happens
An increased risk of respiratory and CNS depression and an increased risk of paralytic ileus
Interaction Deep Dive
When buprenorphine is given together with an anticholinergic CNS depressant, the combined CNS depression can heighten the likelihood of respiratory depression, deep sedation, coma, and death, and it may additionally provoke urinary retention and/or severe constipation, potentially progressing to paralytic ileus. Discontinuing benzodiazepines or other CNS depressants is favored rather than using them alongside buprenorphine. For certain patients, it may be suitable to observe them in a higher level of care or to taper the agent. For others, slowly weaning a patient off a prescribed benzodiazepine or other CNS depressant, or reducing to the lowest effective dose, may be appropriate. When combined use cannot be avoided, watch for urinary retention, severe constipation, sedation, and respiratory depression, and weigh alternative therapies for managing anxiety or insomnia1. A Swedish epidemiological investigation found that patients on methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants face a greater risk of death. Analysis of pooled nationwide death certificate records spanning 2010 to 2014 showed that most overdose deaths involving buprenorphine and methadone also involved concurrent CNS depressant use. Whether the overdose death risk with concomitant CNS depressants varied between buprenorphine and methadone remains unknown 2.
Why it happens (mechanism)
Additive CNS depression; additive effects on gastric motility
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise, especially if buprenorphine is part of your treatment for opioid use disorder. Your team can manage this together.
- Your team may use the lowest effective dose of each and monitor you more closely.
- They may suggest a non-sedating alternative for nausea or dizziness.
- Watch for and report heavy drowsiness, slow or shallow breathing, severe constipation, or trouble urinating.
- Ask your pharmacist or prescriber before adding, stopping, or changing either medicine.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) A Swedish epidemiological study reported that patients receiving methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, medications used to treat insomnia) have an increased risk of death. From July 1, 2005 to December 31, 2012, researchers 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 in MAT prescribed patients (aged 18 to 50). The findings showed a higher 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 an elevated 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 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) According to a study of aggregate nationwide death certificate data spanning 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were often reported as contributing agents in 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, although 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 Meclizine together?
Taking buprenorphine with meclizine can add up to more sedation, slowed breathing, and worse constipation or urinary retention. Use the lowest doses, watch for those symptoms, and talk to your pharmacist or doctor before making changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Meclizine 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 Meclizine interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise, especially if buprenorphine is part of your treatment for opioid use disorder. Your team can manage this together. Your team may use the lowest effective dose of each and monitor you more closely. They may suggest a non-sedating alternative for nausea or dizziness. Watch for and report heavy drowsiness, slow or shall… 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 Meclizine 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: 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 Meclizine
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