Buprenorphine and Ozanimod: 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
Ozanimod
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. Buprenorphine is a strong pain medicine (an opioid), and ozanimod is used for conditions like multiple sclerosis or ulcerative colitis. One of ozanimod's breakdown products can act a bit like an older class of drugs called MAOIs. When an opioid and an MAOI-like drug are combined, there's a concern for a serious reaction called serotonin syndrome and for stronger opioid effects. Ozanimod can also slow your heart rate.
Right now this concern is mostly theoretical, but because it could be serious, please don't stop either medicine on your own. Let your pharmacist or doctor know you take both so they can look at the safest plan for you.
Direction: additive serotonergic and opioid-toxicity risk plus additive negative chronotropic effects. An active ozanimod metabolite inhibits MAO-B in vitro; combining with an opioid that raises serotonin/norepinephrine raises theoretical risk of serotonin syndrome and opioid toxicity (analogous to opioid + MAOI, which can be fatal).
- Mechanism: MAO-B inhibition (additive serotonergic/adrenergic); ozanimod-related bradycardia and AV conduction delay.
- Evidence: theoretical; severity major; onset unspecified.
- Management: generally avoid concomitant use. Assess cardiac status; ozanimod is typically not initiated with QT-prolonging/arrhythmogenic agents. Monitor for serotonin syndrome (autonomic instability, hyperreflexia, agitation) and opioid toxicity. Obtain cardiology input if unavoidable.
What happens
An increased risk of serotonin syndrome or opioid-related toxicity, an increased risk of serious adverse reactions and additive effects on heart rate
Interaction Deep Dive
Giving buprenorphine together with MAOIs, or starting buprenorphine within 14 days of MAOI exposure, is advised against because of a heightened risk of serotonin syndrome and opioid toxicity1. In vitro, an active metabolite of ozanimod inhibits MAO-B, which creates the potential for serious adverse reactions when ozanimod is combined with agents capable of raising norepinephrine or serotonin (for instance, opioid drugs). Concurrent use of opioids with MAOIs, including selective MAO-B inhibitors, has triggered serious and occasionally fatal adverse reactions. Ozanimod may also cause a transient reduction in heart rate along with atrioventricular conduction delays. Its use has not been evaluated in patients receiving QT-prolonging medications. Because of possible additive effects on heart rate, ozanimod therapy should generally not be started in patients already being treated with QT-prolonging drugs that have recognized arrhythmogenic properties. When such concurrent use cannot be avoided, consultation with a cardiologist is warranted 2.
Why it happens (mechanism)
Additive serotonergic effects; MAO-B inhibition and additive effects on heart rate
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise, and make sure every prescriber and your pharmacist knows you take both.
- Your team may decide to avoid using these together, or may monitor you more closely if they must be combined.
- They may check your heart rate and heart rhythm, especially when ozanimod is being started.
- Ask about warning signs of a serious reaction: agitation, confusion, fast heartbeat, sweating, shivering, muscle twitching, fever, or feeling very drowsy or slowed down.
- If any of those happen, seek medical help right away.
Your care team can manage this by tailoring the plan and, if needed, getting a cardiologist's advice.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Buprenorphine and Ozanimod together?
Combining buprenorphine and ozanimod carries a serious (though theoretical) risk of serotonin syndrome, opioid toxicity, and slowed heart rate, so this pairing is generally avoided. Tell your pharmacist or doctor you take both and watch for agitation, fever, muscle twitching, or a very slow heartbeat. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Ozanimod 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 Ozanimod interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise, and make sure every prescriber and your pharmacist knows you take both. Your team may decide to avoid using these together, or may monitor you more closely if they must be combined. They may check your heart rate and heart rhythm, especially when ozanimod is being started. Ask about warning signs of a serious react… Management is individual — always follow your own care team's guidance.
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 Ozanimod 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: ZEPOSIA(R) oral capsules, ozanimod oral capsules. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2024. DailyMed
Keep reading about Buprenorphine
Keep reading about Ozanimod
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