Buprenorphine and Sertindole: 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
Sertindole
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 (an opioid used for pain or opioid use disorder) together with sertindole (a medicine for psychosis) can add up in two ways. First, both drugs can affect your heart's rhythm by stretching out the QT interval, which in rare cases can cause a dangerous heartbeat. Second, both can slow your brain and breathing, causing heavy sedation, very slow breathing, or worse.
Please don't stop either medicine on your own. This is a real concern, but your doctor and pharmacist can manage it by picking safer options, using the lowest doses that work, watching you closely, and sometimes checking an EKG. Let them know you take both.
Effect: Additive QT prolongation plus additive CNS and respiratory depression. This is a pharmacodynamic interaction, not a metabolic one; neither drug requires activation.
- Direction: Increased risk of torsades-type arrhythmia and of profound sedation, respiratory depression, coma, and death.
- Evidence: Probable; severity major. Onset unspecified.
- Management: Avoid combining buprenorphine with QT-prolonging agents where possible. If coadministration is necessary, use lowest effective doses, monitor ECG/QTc, electrolytes, and respiratory/sedation status, and strongly consider prescribing naloxone. Do not withhold MAT solely because of concurrent CNS depressant use.
What happens
An increased risk of QT interval prolongation and an increased risk of CNS and respiratory depression
Interaction Deep Dive
Do not use buprenorphine together with agents capable of prolonging the QT interval. Combining these medications also raises the likelihood of respiratory depression, profound sedation, coma, and death. Discontinuing benzodiazepines or other CNS depressants is favored rather than using them alongside buprenorphine. Depending on the situation, it may be suitable to observe the patient within a higher level of care or to implement a taper. In other circumstances, slowly weaning a patient off a prescribed benzodiazepine or other CNS depressant, or lowering the dose to the smallest effective amount, may be appropriate. When concurrent use cannot be avoided, exercise careful monitoring and management; think about alternative approaches for treating anxiety or insomnia and give strong consideration to prescribing naloxone for emergency management of opioid overdose2. A Swedish epidemiological study found that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) in combination with benzodiazepines or other CNS depressants (for example, medications used for insomnia) have an elevated risk of death. Based on an analysis of pooled nationwide death certificate data spanning 2010 to 2014, the majority of overdose deaths involving buprenorphine and methadone also involved concurrent CNS depressant use. Whether the risk of overdose death from concomitant CNS depressant drugs varied between buprenorphine and methadone remains unknown3.
Why it happens (mechanism)
Additive QT interval prolongation; additive CNS depression
How to manage this interaction
Keep taking both medicines exactly as prescribed until your care team advises otherwise. Bring this combination to your prescriber's or pharmacist's attention.
- Your team may look for a safer alternative for one drug, or use the lowest effective dose of each.
- They may monitor you more closely, including an EKG to check your heart rhythm and checks of your alertness and breathing.
- Ask whether a naloxone rescue kit is appropriate for you.
- Get emergency help for severe drowsiness, confusion, slow or shallow breathing, fainting, or an irregular heartbeat.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) A Swedish epidemiological study found that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) in combination with benzodiazepines or other CNS depressants (for example, agents used to treat insomnia) have an increased risk of death. Among MAT-treated patients aged 18 to 50, the risk of fatal overdose, non-overdose related mortality, and all-cause mortality was compared between periods when CNS depressants were prescribed and periods without CNS depressant therapy, over the interval from July 1, 2005 to December 31, 2012. 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 combined MAT and benzodiazepine treatment; however, these data were not deemed statistically significant. Although results indicated an increased risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods of coadministration of MAT and non-benzodiazepines, only the data for fatal overdose and all-cause mortality 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. No comparison between the benzodiazepine cohort and the non-benzodiazepine cohort was performed because the authors did not adjust for the indication for which the drugs were used 3.
b) In a study of pooled nationwide death certificate data spanning 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were commonly implicated in those deaths. Concurrent use of ALPRAZolam appeared in 18.1% of cases, followed by oxyCODONE (10.1%), cocaine (9.6%), heroin (9%), and diazePAM (6.6%). The FDA recorded 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 deaths involving methadone was 10 times that of deaths involving buprenorphine, though confounding factors and differences in drug use were not taken into account. Whether the risk of overdose death with concurrent CNS depressant drugs differed between buprenorphine and methadone remains unknown 3.
c) Comprehensive QT studies of buprenorphine products have shown modest QT prolongation of 15 msec or less 1.
Common questions
Can I take Buprenorphine and Sertindole together?
Combining buprenorphine and sertindole adds up the risk of a dangerous heart rhythm and of dangerously slowed breathing and sedation, so this pairing is usually avoided; if both are needed, your care team will use the lowest doses, monitor closely, and may provide naloxone. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Sertindole 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 Sertindole interaction managed?
Keep taking both medicines exactly as prescribed until your care team advises otherwise. Bring this combination to your prescriber's or pharmacist's attention. Your team may look for a safer alternative for one drug, or use the lowest effective dose of each. They may monitor you more closely, including an EKG to check your heart rhythm and checks of your alertness and breathing. Ask whether a nalo… 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 Sertindole 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 Sertindole
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