Buprenorphine and Thiopental: 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
Thiopental
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 (like Belbuca or Sublocade) is an opioid, and thiopental is a strong barbiturate that puts people to sleep, often before surgery or procedures. Both slow down the brain and the drive to breathe. When they are used together, those effects can add up, which can lead to heavy sedation, dangerously slow or shallow breathing, and in serious cases coma or death.
The good news is that this is well known and manageable. If you take buprenorphine and a procedure with thiopental is being planned, tell every member of your care team. They can watch your breathing closely and adjust doses so you stay safe. Please don't stop either medicine on your own, just talk with your doctor or pharmacist first.
Effect: Additive CNS and respiratory depression when buprenorphine is combined with thiopental (a barbiturate anesthetic). Risk includes profound sedation, respiratory depression, coma, and death.
Mechanism: Pharmacodynamic (additive CNS depression); neither agent's metabolism is the driver here.
- Severity: Major; Evidence: probable; Onset: unspecified.
- Management: Use lowest effective doses; if co-administration is necessary (e.g., procedural sedation), monitor respiratory status, sedation, and oxygenation in an appropriately equipped setting. Have reversal and airway support available.
- Do not withhold MAT with buprenorphine; balance risk against the mortality risk of untreated opioid use disorder.
What happens
An increased risk of respiratory depression and CNS depression
Interaction Deep Dive
When buprenorphine is given together with a CNS depressant, the combined effect can heighten CNS depression and raise the likelihood of respiratory depression, deep sedation, coma, and death. Discontinuing the CNS depressant is favored over using the two agents together. In certain situations, observing the patient in a higher level of care or performing a taper may be suitable. In other situations, it may be appropriate to slowly wean a patient off a prescribed CNS depressant or lower it to the smallest effective dose. Should concurrent use be required, exercise caution in monitoring and managing the patient, and weigh alternative approaches for managing anxiety or insomnia2. A Swedish epidemiological study found that patients on methadone- or buprenorphine-based medication-assisted treatment (MAT) who also took benzodiazepines or other CNS depressants (for instance, medications used for insomnia) face a greater 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 the concurrent use of a CNS depressant. Whether the risk of overdose death from 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
This combination can be managed safely with the right precautions.
- Keep both providers informed: tell your surgical or anesthesia team that you take buprenorphine, and tell your buprenorphine prescriber about any planned procedure.
- Expect closer monitoring: thiopental is typically given in a hospital or procedure setting, where your breathing, oxygen, and sedation level can be watched closely.
- Doses may be individualized by your care team to keep the combined sedative effect as low as safely possible.
- Do not stop your buprenorphine on your own. Access to this medication is important, so any changes should be decided with your prescriber.
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 receiving methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, medications used to treat insomnia) have an increased risk of death. During the period from July 1, 2005 to December 31, 2012, investigators compared the risk of fatal overdose, non-overdose related mortality, and all-cause mortality during intervals when CNS depressants were prescribed against intervals without CNS depressant therapy among MAT-prescribed patients (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 combined MAT and benzodiazepine treatment; however, these data were not regarded as statistically significant. Although the results indicated a raised risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods of coadministration of MAT and non-benzodiazepines, 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. A comparison between the benzodiazepine cohort and the non-benzodiazepine cohort was not performed because the authors did not adjust for the indication for which the drugs were used 3.
b) An analysis of aggregate nationwide death certificate data from 2010 to 2014 documented 3495 drug overdose deaths reported in 2014. Methadone and other CNS depressants were commonly cited as contributors to those deaths. Concurrent ALPRAZolam use was reported 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. 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 the number involving buprenorphine, although 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 is unknown 3.
Common questions
Can I take Buprenorphine and Thiopental together?
Combining buprenorphine with thiopental adds up their sedative effects and can dangerously slow breathing, so this should only happen with close monitoring by your care team. Never stop your buprenorphine on your own; discuss any planned procedure with all of your providers. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Thiopental 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 Thiopental interaction managed?
This combination can be managed safely with the right precautions. Keep both providers informed: tell your surgical or anesthesia team that you take buprenorphine, and tell your buprenorphine prescriber about any planned procedure. Expect closer monitoring: thiopental is typically given in a hospital or procedure setting, where your breathing, oxygen, and sedation level can be watched closely. Dos… 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 Thiopental 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 Thiopental
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