Buprenorphine and Triazolam: 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
Triazolam
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.
Both of these medicines calm down your brain and nervous system. Buprenorphine is an opioid, and triazolam (Halcion) is a benzodiazepine used for sleep. When taken together, their calming effects add up. This can cause heavy drowsiness, slowed breathing, and in serious cases it can become life-threatening.
This is an important combination to take seriously, but it can be managed. Please don't stop either medicine on your own. Talk with your doctor or pharmacist. They may adjust doses, watch you more closely, or look at other options for sleep or anxiety so you stay safe.
Effect: Additive CNS and respiratory depression from combining buprenorphine (partial opioid agonist) with triazolam (benzodiazepine). Risk of profound sedation, respiratory depression, coma, and death.
Mechanism: Pharmacodynamic (additive CNS depression), not a PK/enzyme interaction. Neither is a prodrug relevant here.
- Evidence: Probable; supported by epidemiologic overdose-death data (Swedish MAT cohort; US death-certificate analyses 2010-2014).
- Severity: Major. Onset: unspecified.
- Management: Prefer avoidance; taper or reduce to lowest effective dose; consider alternatives for insomnia/anxiety. If combined, monitor mental status and respiratory status closely, possibly higher level of care. Do not withhold MAT solely due to CNS depressant use.
What happens
An increased risk of CNS depression and respiratory depression
Interaction Deep Dive
When buprenorphine is given together with a benzodiazepine, the CNS depressant effects can be additive, raising the likelihood of respiratory depression, deep sedation, coma, and death. Discontinuing benzodiazepines or other CNS depressants is favored rather than using them at the same time. Monitoring within a higher level of care or a taper may be suitable in certain situations. In other situations, it may be suitable to slowly taper a patient off a prescribed benzodiazepine or other CNS depressant, or to reduce it to the lowest dose that remains effective. When concurrent use cannot be avoided, watch for respiratory depression and proceed with caution in management1. 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 example, agents used to treat insomnia) had an elevated risk of death. Analysis of aggregate nationwide death certificate data spanning 2010 to 2014 showed that most overdose deaths involving buprenorphine and methadone also involved concurrent CNS depressant use. Whether the risk of overdose death 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
This combination adds up the sedating effects of both drugs, so your care team will manage it carefully. Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Your team may prefer to taper the triazolam or reduce it to the lowest effective dose, or look at alternatives for sleep or anxiety.
- Doses may be adjusted and individualized, and your team may monitor you more closely.
- Watch for warning signs: unusual sleepiness, confusion, slowed or shallow breathing, or trouble waking. Seek emergency help right away if these occur.
Ask your pharmacist or prescriber before making any change. Importantly, needing sleep or anxiety medicine should not stop you from receiving buprenorphine treatment.
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 receiving 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. Between July 1, 2005 and December 31, 2012, investigators analyzed, among MAT-prescribed patients (aged 18 to 50), the risk of fatal overdose, non-overdose related mortality, and all-cause mortality during periods when CNS depressants were prescribed compared with periods without CNS depressant therapy. 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, this data was not considered statistically significant. Although the results showed 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. 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 commonly cited as contributors in 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 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. It remains unknown whether the risk of overdose death with concurrent CNS depressant drugs differed between buprenorphine and methadone 3.
Common questions
Can I take Buprenorphine and Triazolam together?
Combining buprenorphine with triazolam adds up their sedating effects and raises the risk of dangerously slowed breathing, so use them together only under close medical supervision and never change either medicine on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Triazolam 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 Triazolam interaction managed?
This combination adds up the sedating effects of both drugs, so your care team will manage it carefully. Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Your team may prefer to taper the triazolam or reduce it to the lowest effective dose, or look at alternatives for sleep or anxiety. Doses may be adjusted and individualized, and your team may monitor you more cl… 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 Triazolam 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 Triazolam
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