Buprenorphine and Secobarbital: 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
Secobarbital
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.
Buprenorphine is a strong pain and opioid-treatment medicine, and secobarbital is a barbiturate that calms the brain and helps with sleep. Both slow down your brain and breathing. Taken together, that slowing can add up and become dangerous, causing heavy sedation, very slow breathing, and in the worst cases coma or death.
This is a serious combination, but it can be managed. Please don't stop or change either medicine on your own. Talk with your pharmacist or doctor so they can review your doses, watch you more closely, and decide the safest plan for you. If you ever feel unusually drowsy, confused, or short of breath, get help right away.
Interaction: Additive CNS and respiratory depression from combining buprenorphine (partial opioid agonist) with secobarbital (barbiturate CNS depressant). Neither is a prodrug here; the effect is pharmacodynamic, not metabolic.
- Direction: Additive/synergistic CNS depression, increasing risk of profound sedation, respiratory depression, coma, and death.
- Evidence: Probable; epidemiologic overdose-death data support the risk.
- Onset: Unspecified.
- Management: Avoid coadministration where possible. Prefer tapering or discontinuing the CNS depressant, or use the lowest effective dose. Consider alternatives for anxiety/insomnia. If combined, monitor respiratory status closely, possibly in a higher level of care. Do not withhold MAT.
What happens
An increased risk of respiratory depression and CNS depression
Interaction Deep Dive
When buprenorphine is given together with a CNS depressant, the CNS depressant effects can combine, raising the likelihood of respiratory depression, deep sedation, coma, and death. Discontinuing the CNS depressant is favored over using the two together. Certain situations may warrant monitoring at a higher level of care or a taper. In other situations, it may be suitable to slowly wean a patient off a prescribed CNS depressant or to reduce it to the smallest effective dose. When combined use cannot be avoided, exercise careful monitoring and management, and think about alternative approaches for treating anxiety or insomnia2. A Swedish epidemiological study found that patients on methadone- or buprenorphine-based medication-assisted treatment (MAT) who also take benzodiazepines or other CNS depressants (for instance, medications used for insomnia) have a heightened risk of death. Based on an analysis of nationwide death certificate data pooled from 2010 to 2014, most overdose deaths that involved buprenorphine and methadone also involved concurrent CNS depressant use. Whether the overdose death risk associated with concomitant CNS depressant drugs varied between buprenorphine and methadone is not known 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
What your care team may do:
- Prefer stopping or slowly tapering the secobarbital, or using the lowest effective dose, rather than long-term use with buprenorphine.
- Consider safer alternatives for sleep or anxiety.
- Watch you more closely for slowed breathing and heavy sedation, sometimes in a higher level of care.
What you should do:
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise, do not stop suddenly on your own.
- Ask your pharmacist or doctor whether your doses can be adjusted or individualized for safety.
- Get urgent help for extreme drowsiness, confusion, or trouble breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) A Swedish epidemiological study found that patients who receive methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, medications used for insomnia) have an increased risk of death. From July 1, 2005 to December 31, 2012, investigators examined the risk of fatal overdose, non-overdose related mortality, and all-cause mortality by comparing periods when CNS depressants were prescribed with periods when no CNS depressant therapy was used, in patients receiving MAT (aged 18 to 50). The findings showed a raised 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 combined with benzodiazepine treatment; however, these data were not deemed statistically significant. Although the results showed an increased risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods when MAT and non-benzodiazepines were given together, 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 for which the drugs were used 3.
b) According to a study using aggregate nationwide death certificate data from 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were commonly identified as contributors in these 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 that involved buprenorphine. Of those 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 deaths involving methadone was 10 times the number involving buprenorphine, though confounding factors and differences in drug utilization were not taken into account. It remains unknown whether the risk of overdose death with concomitant CNS depressant drugs differed between buprenorphine and methadone 3.
Common questions
Can I take Buprenorphine and Secobarbital together?
Combining buprenorphine and secobarbital adds up to dangerous slowing of breathing and alertness, so talk with your care team about tapering the barbiturate or safer alternatives and closer monitoring, and never stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Secobarbital 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 Secobarbital interaction managed?
What your care team may do: Prefer stopping or slowly tapering the secobarbital, or using the lowest effective dose, rather than long-term use with buprenorphine. Consider safer alternatives for sleep or anxiety. Watch you more closely for slowed breathing and heavy sedation, sometimes in a higher level of care. What you should do: Keep taking both exactly as prescribed unless your prescriber tell… 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 Secobarbital 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: 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 Secobarbital
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