Buprenorphine and Nalbuphine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buprenorphine
Nalbuphine Injection
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.
What happens
Reduced analgesic effect or precipitation of withdrawal symptoms, and an increased risk of serotonin syndrome and respiratory depression
Interaction Deep Dive
Avoid concomitant use of buprenorphine with a mixed opioid agonist/antagonist or a partial agonist opioid analgesic as this may reduce the analgesic effect of buprenorphine and may precipitate withdrawal symptoms. In addition, coadministration of buprenorphine and a CNS depressant may result in additive CNS depression and an increased risk of serotonin syndrome and respiratory depression, profound sedation, coma, and death. Cessation of other CNS depressants is preferred over concomitant use. In some cases, monitoring in a higher level of care or taper may be appropriate. In others, gradually tapering a patient off a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate. If concomitant use is necessary, monitor for sedation, respiratory depression, and signs and symptoms of serotonin syndrome; consider using alternative options for the treatment of anxiety or insomnia and strongly consider prescribing naloxone for the emergency treatment of opioid overdose1.
Why it happens (mechanism)
Opioid receptor antagonism; additive serotonergic effects and respiratory depression
Common questions
Can I take Buprenorphine and Nalbuphine Injection together?
Reduced analgesic effect or precipitation of withdrawal symptoms, and an increased risk of serotonin syndrome and respiratory depression Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Nalbuphine Injection 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 strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Buprenorphine or Nalbuphine Injection 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 (1)
- Product Information: SUBUTEX(R) sublingual tablets, buprenorphine sublingual tablets. Indivior Inc (per FDA), North Chesterfield, VA, 2021. DailyMed
Keep reading about Buprenorphine
Keep reading about Nalbuphine Injection
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