Buprenorphine and Temazepam: 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
Temazepam
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 (an opioid used for pain or for treating opioid use disorder) and temazepam (Restoril, a benzodiazepine sleep medicine) both slow down your brain and breathing. Taken together, those calming effects can stack up. This can cause heavy drowsiness, very slow or shallow breathing, and in serious cases it can be life-threatening.
This is a real and well-documented concern, so please don't ignore it, but also don't stop either medicine on your own. Your care team can manage this safely. Tell your pharmacist or doctor that you take both, and watch for unusual sleepiness, confusion, or trouble breathing. If breathing becomes very slow or you can't wake someone, call emergency services right away.
Effect: Additive CNS and respiratory depression from combining buprenorphine (opioid partial agonist) with temazepam (benzodiazepine). Risk includes profound sedation, respiratory depression, coma, and death. This is a pharmacodynamic interaction; neither is a prodrug and no PK activation change is involved.
- Severity: Major. Evidence: Probable, supported by epidemiologic overdose/mortality data.
- Management: Avoid concomitant use when possible; prefer tapering the benzodiazepine or lowest effective dose. Do not withhold MAT to avoid the combination, as untreated OUD carries higher mortality.
- Monitor: Mental status, sedation level, respiratory rate. Consider alternatives for anxiety/insomnia.
What happens
An increased risk of CNS depression and respiratory depression
Interaction Deep Dive
When buprenorphine is given together with a benzodiazepine, the two may produce additive depression of the CNS, raising the likelihood of respiratory depression, deep sedation, coma, and death. Rather than using them together, discontinuing the benzodiazepine or another CNS depressant is the preferred approach. Depending on the situation, it may be suitable to observe the patient at a higher level of care or to carry out a taper. In other circumstances, it may be appropriate to slowly wean the patient off a prescribed benzodiazepine or other CNS depressant, or to reduce it to the smallest dose that remains effective. Should concurrent use be unavoidable, watch for respiratory depression and proceed with caution in management1. A Swedish epidemiological study found that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) who also took benzodiazepines or other CNS depressants (such as agents used for insomnia) had a heightened risk of death. Based on an analysis of pooled nationwide death certificate data spanning 2010 to 2014, most overdose deaths involving buprenorphine and methadone also involved concurrent use of a CNS depressant. Whether this risk of overdose death from concurrent CNS depressant use varied between buprenorphine and methadone remains unknown 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Keep taking both as prescribed unless your prescriber tells you otherwise. This combination can be managed, but it needs your care team's attention.
- Tell your pharmacist and prescriber you take both drugs.
- Your team may lower the temazepam dose, slowly taper it, or suggest a different option for sleep or anxiety.
- Doses may be adjusted and individualized, and your team may monitor you more closely for sedation and breathing changes.
- Never stop buprenorphine (MAT) on your own to avoid this combination.
- Seek emergency help for extreme drowsiness, confusion, or slow/shallow breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) A Swedish epidemiological study reported that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, agents used to treat insomnia) have a heightened risk of death. Between July 1, 2005 and December 31, 2012, investigators compared the risk of fatal overdose, non-overdose related mortality, and all-cause mortality during periods of prescribed CNS depressants versus periods without CNS depressant therapy in MAT-prescribed patients (aged 18 to 50). The findings showed an increased 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 and benzodiazepine treatment; however, these data were not deemed statistically significant. Although the results also indicated an elevated 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. The authors did not compare the benzodiazepine cohort with the non-benzodiazepine cohort because they did not adjust for the indication of use for the drugs 3.
b) According to a study of aggregate nationwide death certificate data from 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were frequently identified as contributors in those 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 involving buprenorphine. Of 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 methadone-involved deaths was 10 times the number of buprenorphine-involved deaths, though confounding factors and differences in drug utilization were not taken into account. Whether the risk of overdose death with concomitant CNS depressant drugs differed between buprenorphine and methadone remains unknown 3.
Common questions
Can I take Buprenorphine and Temazepam together?
Combining buprenorphine and temazepam adds up to dangerous sedation and slowed breathing, so tell your care team you take both. They can manage it by adjusting doses, monitoring you, or choosing a safer sleep or anxiety option, but never stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Temazepam 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 Temazepam interaction managed?
Keep taking both as prescribed unless your prescriber tells you otherwise. This combination can be managed, but it needs your care team's attention. Tell your pharmacist and prescriber you take both drugs. Your team may lower the temazepam dose, slowly taper it, or suggest a different option for sleep or anxiety. Doses may be adjusted and individualized, and your team may monitor you more closely… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Buprenorphine or Temazepam 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 Temazepam
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