Buprenorphine and Telithromycin: 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
Telithromycin
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. Telithromycin is an antibiotic that slows down a liver enzyme (called CYP3A4) that normally breaks down your buprenorphine. When that enzyme is slowed, more buprenorphine can build up in your body. That can mean stronger opioid effects, like heavy sedation and slowed breathing.
On top of that, both medicines can affect your heart's rhythm (something called QT prolongation), and using them together can add to that risk.
The good news: this is very manageable. Please don't stop or change either medicine on your own. Talk with your doctor or pharmacist, they can adjust your buprenorphine dose and keep a closer eye on you.
Effect: Increased buprenorphine exposure plus additive QT prolongation risk.
Mechanism: Telithromycin is a potent CYP3A4 inhibitor, reducing buprenorphine metabolism and raising plasma concentrations. Both agents independently prolong the QT interval (additive PD effect). Neither is a prodrug in this pathway.
Evidence/onset: Probable; onset unspecified. Severity major.
- Monitor ECG/QT, especially with other risk factors or electrolyte disturbances.
- Consider reducing buprenorphine dose until stable; monitor closely for sedation and respiratory depression.
- On discontinuing telithromycin, anticipate a possible buprenorphine dose increase and watch for withdrawal.
- For subQ depot formulations, monitor for over-medication; transition to a titratable formulation if precise adjustment is 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
Because a CYP3A4 inhibitor can raise buprenorphine plasma concentrations, using it together with buprenorphine may lead to extended opioid effects, such as respiratory depression. The concurrent use of agents that influence cardiac conduction also raises the likelihood of QT prolongation. When these drugs are given together, watch the patient carefully for any lengthening of the QT interval. It may be appropriate to lower the buprenorphine dose until consistent drug effects are reached, while frequently checking for sedation and respiratory depression. If a CYP3A4 inhibitor is stopped in a patient on buprenorphine, consider raising the buprenorphine dose until stable effects are obtained, and observe for indications of opioid withdrawal2. When the dose cannot be modified once the CYP3A4 inhibitor is no longer present, switch the patient back to a buprenorphine formulation that allows more exact dose titration. For patients transitioned from transmucosal buprenorphine given with CYP3A4 inhibitors, confirm that the plasma buprenorphine concentration delivered by subQ buprenorphine is sufficient. In patients already receiving subQ buprenorphine who then need a CYP3A4 inhibitor, watch for indications of over-medication. Should buprenorphine toxicity or overdose become apparent while the coadministered drug cannot be lowered or stopped, decrease the buprenorphine dose. If the available doses do not allow the intended dose to be reached, halt treatment and manage the patient with a buprenorphine formulation that supports 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 as prescribed unless your care team tells you otherwise. This combination can be managed with dose tailoring and closer monitoring.
Here's what your team may do:
- Check your heart rhythm (an ECG) for QT changes.
- Adjust your buprenorphine dose, individualized to you, until effects are stable.
- Watch closely for too much sedation and slowed breathing.
- When the antibiotic is stopped, re-check your buprenorphine dose so you don't have withdrawal.
Call your prescriber or pharmacist if you notice unusual drowsiness, very slow or shallow breathing, confusion, fainting, or a pounding/irregular heartbeat.
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), an increase in Cmax by 3.9-fold (from 0.057 to 0.22 ng/mL), a longer half-life (from 9.1 to 14.5 hours), and greater urinary clearance (from 0.31 to 0.73 L/hr). Voriconazole likewise significantly raised exposure to the active metabolite, norbuprenorphine, by nearly 4-fold for AUC(0 to 18 hours) and by 3.3-fold for Cmax, and reduced 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 crossing 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 concurrently administered CYP3A4 inhibitors on buprenorphine exposure in patients receiving subQ buprenorphine has not been investigated; nevertheless, these interactions have been demonstrated in studies employing transmucosal buprenorphine. The effects of buprenorphine may vary according to the route of administration 1.
Common questions
Can I take Buprenorphine and Telithromycin together?
Combining buprenorphine with telithromycin can raise buprenorphine levels (more sedation and slowed breathing) and add to QT heart-rhythm risk; keep taking both as prescribed but ask your care team about dose adjustment and monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Telithromycin 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 Telithromycin interaction managed?
Keep taking both as prescribed unless your care team tells you otherwise. This combination can be managed with dose tailoring and closer monitoring. Here's what your team may do: Check your heart rhythm (an ECG) for QT changes. Adjust your buprenorphine dose, individualized to you, until effects are stable. Watch closely for too much sedation and slowed breathing. When the antibiotic is stopped, r… 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 Telithromycin 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 Telithromycin
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