Buprenorphine and Nilotinib: 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
Nilotinib
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.
Taking buprenorphine and nilotinib together needs some extra care. Nilotinib slows down a liver enzyme (called CYP3A4) that normally clears buprenorphine out of your body. When that clearance slows, buprenorphine can build up, which may make its effects stronger and last longer. That can mean more sleepiness and, in some cases, slowed breathing.
On top of that, both drugs can affect your heart's rhythm (something called QT prolongation), so using them together can add to that risk. The good news is that your care team can manage this by adjusting your buprenorphine dose, watching you more closely, and checking your heart rhythm. Please don't change anything on your own. Talk with your pharmacist or doctor.
Mechanism: Nilotinib inhibits CYP3A4-mediated metabolism of buprenorphine (neither is a relevant prodrug here), increasing buprenorphine exposure. Both agents independently prolong the QT interval, giving additive cardiac risk.
Effect / direction: Increased buprenorphine plasma levels and prolonged opioid effect (sedation, respiratory depression), plus increased QT prolongation risk.
- Severity: Major. Evidence: Probable. Onset: Unspecified.
- Management: Monitor ECG/QTc and electrolytes. Consider reducing buprenorphine dose until stable; monitor closely for sedation and respiratory depression. On nilotinib discontinuation, consider a buprenorphine dose increase and watch for withdrawal. Use formulations allowing precise titration when needed.
What happens
An increased risk of QT interval prolongation, increased buprenorphine exposure and an increased risk of buprenorphine-related adverse events
Interaction Deep Dive
When buprenorphine is taken together with a CYP3A4 inhibitor, buprenorphine plasma concentrations rise, which may lead to extended opioid effects such as respiratory depression. The risk of QT prolongation is also heightened when drugs that influence cardiac conduction are given at the same time. In cases of coadministration, watch the patient carefully for any lengthening of the QT interval. It is advisable to lower the buprenorphine dose until drug effects stabilize, while checking frequently for sedation and respiratory depression. If a CYP3A4 inhibitor is stopped in someone on buprenorphine, consider raising the buprenorphine dose until stable effects are reached, and observe for indications of opioid withdrawal2. When the dose cannot be modified once the CYP3A4 inhibitor is removed, switch the patient back to a buprenorphine formulation that allows finer dose titration. For patients moved from transmucosal buprenorphine taken with CYP3A4 inhibitors, confirm that the buprenorphine plasma level delivered by subQ buprenorphine is sufficient. When a patient already receiving subQ buprenorphine needs a CYP3A4 inhibitor, watch for indications of over-medication. Should signs and symptoms of buprenorphine toxicity or overdose develop while the accompanying medication cannot be lowered or stopped, decrease the buprenorphine dose. If the available doses cannot deliver the target dose, halt treatment and manage the patient with a buprenorphine formulation that allows more precise dose adjustments 1.
Why it happens (mechanism)
Additive QT interval prolongation; inhibition of CYP3A4-mediated metabolism of buprenorphine
How to manage this interaction
Keep taking both medications as prescribed unless your care team tells you otherwise. This combination is manageable with the right monitoring.
Here is what your team may do:
- Reduce your buprenorphine dose until your response is steady, then monitor for sedation and slowed breathing.
- Check your heart rhythm (an ECG) and watch your QT interval.
- If nilotinib is later stopped, they may raise your buprenorphine dose again and watch for withdrawal signs.
- Possibly switch to a buprenorphine form that allows more precise dose changes.
Call your pharmacist or doctor right away if you feel very drowsy, confused, faint, or notice slow or shallow breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In a study of healthy volunteers (N=12), giving oral buprenorphine together with voriconazole produced a significant rise in the mean AUC(0 to 18 hours) of buprenorphine by 4.3-fold (from 0.43 to 2.1 nanograms (ng) x hr/mL), in Cmax by 3.9-fold (from 0.057 to 0.22 ng/mL), in half-life (from 9.1 to 14.5 hours), and in urinary clearance (from 0.31 to 0.73 L/hr). Voriconazole likewise significantly raised exposure to the active metabolite, norbuprenorphine, by almost 4-fold for AUC(0 to 18 hours) and by 3.3-fold for Cmax, and lowered renal clearance (from 7.2 to 2.9 L/hr). Participants reported mild dizziness and nausea in both phases. Subjects were given either placebo or voriconazole 400 mg twice daily on day 1, and 200 mg twice daily on days 2 to 5, followed by a 4-week washout period before switching over to the alternate regimen. On the fifth day, every subject received a single dose of buprenorphine 0.2 mg orally, or 3.6 mg during the placebo phase 3.
b) The impact of concurrent CYP3A4 inhibitors on buprenorphine exposure in patients receiving subQ buprenorphine has not been investigated; nevertheless, such interactions have been demonstrated in studies employing transmucosal buprenorphine. The effects of buprenorphine may depend on the route of administration 1.
Common questions
Can I take Buprenorphine and Nilotinib together?
Nilotinib can raise buprenorphine levels and both drugs can affect heart rhythm, so your care team may lower your buprenorphine dose and monitor your breathing and ECG closely. Keep taking both as prescribed and report severe drowsiness or slow breathing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Nilotinib 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 Nilotinib interaction managed?
Keep taking both medications as prescribed unless your care team tells you otherwise. This combination is manageable with the right monitoring. Here is what your team may do: Reduce your buprenorphine dose until your response is steady, then monitor for sedation and slowed breathing. Check your heart rhythm (an ECG) and watch your QT interval. If nilotinib is later stopped, they may raise your bup… 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 Nilotinib 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: ZUBSOLV(R) sublingual tablets, buprenorphine naloxone sublingual tablets. Orexo US Inc (per FDA), Morristown, NJ, 2023. DailyMed
- Fihlman M, Hemmila T, Hagelberg NM, et al: Voriconazole greatly increases the exposure to oral buprenorphine. Eur J Clin Pharmacol 2018; 74(12):1615-1622. PubMed
Keep reading about Buprenorphine
Keep reading about Nilotinib
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