Flurazepam 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
Buprenorphine
Flurazepam
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.
Both of these medicines slow down your brain and breathing. Buprenorphine is a strong opioid (used for pain or for opioid use disorder), and flurazepam is a benzodiazepine used for sleep. When you take them together, their calming effects add up. That can lead to too much sleepiness, very slow or shallow breathing, and in serious cases, coma or death.
This is a real and serious combination, so please don't stop either one on your own. Never stop buprenorphine or flurazepam suddenly, since that can be dangerous too. Talk with your pharmacist or doctor. Your care team can adjust things safely and watch you more closely so you get the benefit of both while staying safe.
Mechanism: additive CNS and respiratory depression (pharmacodynamic). Buprenorphine (partial mu-opioid agonist) plus flurazepam (long-acting benzodiazepine) produce combined sedation and respiratory drive suppression. Neither is a prodrug; the effect is additive, not metabolic.
- Direction: increased CNS/respiratory depression risk (profound sedation, coma, death).
- Evidence: probable; epidemiologic data link concomitant MAT plus benzodiazepine use to increased overdose mortality.
- Severity/onset: major; onset unspecified.
- Management: avoid where possible; if flurazepam is for insomnia, prefer non-benzodiazepine alternatives. Where continued use is needed, use lowest effective dose, taper when appropriate, and monitor mental status and respiration. Do not withhold MAT.
What happens
An increased risk of CNS depression and respiratory depression
Interaction Deep Dive
When buprenorphine is given together with a benzodiazepine, the combined effect on the central nervous system 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 alongside buprenorphine. Managing the situation with a higher level of monitoring or a taper may be suitable in certain patients. For others, it may be appropriate to gradually withdraw a patient from a prescribed benzodiazepine or other CNS depressant, or to reduce the dose to the lowest amount that remains effective. Should concurrent use be unavoidable, watch for respiratory depression and proceed with caution1. 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) had an elevated risk of death. Data drawn from aggregate nationwide death certificates spanning 2010 to 2014 showed that most overdose deaths involving buprenorphine and methadone also involved the concurrent use of a CNS depressant. Whether the risk of fatal overdose from concomitant CNS depressant drugs varies between buprenorphine and methadone remains unknown 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Take both exactly as prescribed and do not stop either abruptly. Your care team manages this combination deliberately.
- They may prefer an alternative for sleep or anxiety instead of flurazepam.
- If both are needed, the dose may be adjusted to the lowest effective amount, or a benzodiazepine taper may be planned by your team.
- They may monitor you more closely for excess drowsiness and slowed breathing.
Tell your pharmacist or prescriber right away if you feel unusually sleepy, confused, or short of breath. If you are on buprenorphine for opioid use disorder, keep taking it, that treatment should not be withheld.
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 on methadone- or buprenorphine-based medication-assisted treatment (MAT) who also received benzodiazepines or other CNS depressants (for example, agents used to treat insomnia) have an increased 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 when CNS depressants were prescribed versus periods without CNS depressant therapy in MAT 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 deemed statistically significant. Although results also indicated a heightened risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods of coadministered 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. The authors did not compare the benzodiazepine cohort with the non-benzodiazepine cohort because they did not adjust for the indication for which the drugs were used 3.
b) According to a study of pooled 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 to those deaths. Concurrent use of alprazolam 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 methadone-involved deaths was 10 times that of buprenorphine-involved deaths, although confounding factors and differences in drug utilization were not taken into account. Whether the risk of overdose death with concurrent CNS depressant drugs differed between buprenorphine and methadone is unknown 3.
Common questions
Can I take Flurazepam and Buprenorphine together?
Combining buprenorphine and flurazepam adds up their sedative effects and raises the risk of dangerously slow breathing, so let your care team know and never stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Flurazepam 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 Flurazepam and Buprenorphine interaction managed?
Take both exactly as prescribed and do not stop either abruptly. Your care team manages this combination deliberately. They may prefer an alternative for sleep or anxiety instead of flurazepam. If both are needed, the dose may be adjusted to the lowest effective amount, or a benzodiazepine taper may be planned by your team. They may monitor you more closely for excess drowsiness and slowed breathi… 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 Flurazepam 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 (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 Flurazepam
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