Buspirone with Buprenorphine Interaction Details
Brand Names Associated with Buspirone
- BuSpar®
- Buspirone
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 06, 2024
Interaction Effect
An increased risk of serotonin syndrome and an increased risk of respiratory and CNS depression
Interaction Summary
Coadministration of buprenorphine and a serotonergic CNS depressant may result in additive CNS depression and an increased risk of serotonin syndrome and respiratory depression, profound sedation, coma, and death. Cessation of other CNS depressants is preferred over concomitant use. In some cases, monitoring in a higher level of care or taper may be appropriate. In others, gradually tapering a patient off a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate. If concomitant use is necessary, monitor for sedation, respiratory depression, and signs and symptoms of serotonin syndrome. Carefully observe the patient, particularly during treatment initiation and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected; consider using alternative options for the treatment of anxiety or insomnia[1][2].
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of buprenorphine and a serotonergic CNS depressant may result in additive CNS depression and an increased risk of serotonin syndrome and respiratory depression, profound sedation, coma, and death. Cessation of other CNS depressants is preferred over concomitant use. In some cases, monitoring in a higher level of care or taper may be appropriate. In others, gradually tapering a patient off a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate. If concomitant use is necessary, monitor for sedation, respiratory depression, and signs and symptoms of serotonin syndrome. Carefully observe the patient, particularly during treatment initiation and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected; consider using alternative options for the treatment of anxiety or insomnia[1][2].
Mechanism Of Interaction
Additive serotonergic effects; additive CNS and respiratory depression
Literature Reports
A) An epidemiological study from Sweden reported that patients receiving methadone- or buprenorphine-based medication-assisted treatment (MAT) along with benzodiazepines or other CNS depressants (e.g., drugs that treat insomnia), increase the risk of death. Between July 1, 2005 and December 31, 2012, the risk of fatal overdose, non-overdose related mortality, and all-cause mortality during periods of prescribed CNS depressants to periods of time without CNS depressant therapy were analyzed in MAT prescribed patients (aged 18 to 50). The results found an elevated 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, the data was not considered statistically significant. While results demonstrated an elevated risk of fatal overdose, non-overdose morality, and all-cause mortality during periods of coadministration of MAT and non-benzodiazepines, only the data for fatal overdose and all-cause mortality was considered statistically significant; 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 non-benzodiazepine cohort was not conducted due to the authors not adjusting for the indication of use for the drugs [3].
B) According to a study of aggregate nationwide death certificate data from 2010 to 2014, there were 3495 drug overdose deaths reported in 2014. Methadone and other CNS depressants were frequently reported as culprits 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, although confounding factors and differences in drug utilization were not accounted for. It is unknown whether the risk of overdose death with concomitant CNS depressant drugs differed between buprenorphine and methadone [3].
References
1 ) Product Information: SUBUTEX(R) sublingual tablets, buprenorphine sublingual tablets. Indivior Inc (per FDA), North Chesterfield, VA, 2021.
2 ) Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023.
3 ) 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. Available from URL: https://www.fda.g... . As accessed 2017-09-20.
Buspirone Overview
-
Buspirone is used to treat anxiety disorders or in the short-term treatment of symptoms of anxiety. Buspirone is in a class of medications called anxiolytics. It works by changing the amounts of certain natural substances in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.