Delavirdine and Buprenorphine: 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
Delavirdine
Buprenorphine
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. Delavirdine (Rescriptor) slows down a liver enzyme called CYP3A4 that normally helps break down buprenorphine. When that enzyme is blocked, buprenorphine can build up in your blood, so its effects get stronger and last longer.
The main concern is too much opioid effect, like heavy drowsiness, slowed breathing, or feeling over-sedated. This is considered a serious interaction, but it is very manageable. Please don't stop or change either medicine on your own. Talk with your pharmacist or doctor. Your care team can adjust your buprenorphine dose and watch you a little more closely so you stay safe and comfortable.
Mechanism: Delavirdine is a potent CYP3A4 inhibitor; buprenorphine is a CYP3A4 substrate. Coadministration reduces buprenorphine metabolism, increasing plasma exposure (elevated AUC/Cmax) and the risk of prolonged opioid effects.
Direction: Increased buprenorphine effect and toxicity risk (sedation, respiratory depression). Severity: major. Evidence: probable. Onset: unspecified.
- If starting delavirdine, consider reducing the buprenorphine dose until stable, and monitor frequently for sedation and respiratory depression.
- On discontinuing delavirdine, consider increasing buprenorphine and monitor for withdrawal.
- For subQ depot formulations, monitor for over-medication; if precise titration is needed, transition to a formulation allowing dose adjustment.
What happens
Increased buprenorphine exposure and an increased risk of buprenorphine-related adverse events
Interaction Deep Dive
Taking buprenorphine together with a CYP3A4 inhibitor can raise buprenorphine plasma concentrations, potentially producing extended opioid effects such as respiratory depression. When a patient on buprenorphine needs a CYP3A4 inhibitor, it may be appropriate to lower the buprenorphine dose until drug effects stabilize, with frequent monitoring for sedation and respiratory depression. Conversely, if a CYP3A4 inhibitor is stopped in someone receiving buprenorphine, an increase in the buprenorphine dose can be considered until stable effects are reached, watching for indications of opioid withdrawal2. Should dose adjustment prove impossible once the CYP3A4 inhibitor is no longer present, switch the patient to a buprenorphine formulation that allows finer dose titration. For patients moving from transmucosal buprenorphine given alongside CYP3A4 inhibitors, confirm through monitoring that subQ buprenorphine delivers an adequate plasma buprenorphine level. Patients who are already receiving subQ buprenorphine and then require a CYP3A4 inhibitor should be observed for signs and symptoms of over-medication. Where buprenorphine toxicity or overdose signs and symptoms develop but the co-administered drug cannot be lowered or stopped, decrease the buprenorphine dose. If the available doses will not allow the target dose to be reached, halt treatment and manage the patient with a buprenorphine formulation permitting more precise dose adjustments 1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of buprenorphine
How to manage this interaction
The good news: your care team can manage this. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your buprenorphine dose may need to be adjusted and individualized by your care team while you are on delavirdine, and they may monitor you more closely for sedation or slowed breathing.
- If delavirdine is later stopped, your buprenorphine dose may need to go back up, with monitoring for withdrawal symptoms.
- If you are on a long-acting (injectable) buprenorphine, your team may switch to a form that allows finer dose changes.
Call your pharmacist or prescriber right away if you feel unusually sleepy, confused, or notice slow or shallow breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The impact of concurrently administered CYP3A4 inhibitors on buprenorphine exposure in individuals receiving subQ buprenorphine has not been investigated; nevertheless, these interactions have been documented in studies that used transmucosal buprenorphine. The effects of buprenorphine may depend on the route by which it is administered 1.
Common questions
Can I take Delavirdine and Buprenorphine together?
Delavirdine can raise buprenorphine levels and increase opioid side effects like sedation and slowed breathing, so your care team may lower your buprenorphine dose and watch you more closely; keep taking both as prescribed and report unusual drowsiness or breathing changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Delavirdine and Buprenorphine 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 Delavirdine and Buprenorphine interaction managed?
The good news: your care team can manage this. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your buprenorphine dose may need to be adjusted and individualized by your care team while you are on delavirdine, and they may monitor you more closely for sedation or slowed breathing. If delavirdine is later stopped, your buprenorphine dose may need to go b… 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 Delavirdine or Buprenorphine 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 (2)
- 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
Keep reading about Delavirdine
Keep reading about Buprenorphine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist