Glycopyrrolate 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
Glycopyrrolate
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 can slow down your gut and bladder. Buprenorphine is an opioid pain and addiction medicine, and one of its common side effects is constipation. Glycopyrrolate is an anticholinergic drug, and it can also slow the bowels and make it harder to empty your bladder.
When you take them together, those effects can add up. In rare cases, the gut can slow so much that it nearly stops moving, which is called paralytic ileus. Watch for bad constipation, belly bloating or pain, or trouble urinating. Keep taking both as prescribed, and let your pharmacist or doctor know if these signs show up. This is something your care team can manage.
Interaction: Additive reduction in GI and urinary tract motility from buprenorphine (opioid) plus glycopyrrolate (anticholinergic), theoretically increasing risk of severe constipation, urinary retention, and paralytic ileus.
- Mechanism: Pharmacodynamic (additive); opioid-mediated decreased gut motility plus antimuscarinic inhibition of smooth muscle activity. Not a metabolic/prodrug interaction.
- Direction: Additive adverse effect (reduced motility).
- Evidence: Theoretical; magnitude and onset unspecified.
- Management: Monitor for reduced gastric motility, abdominal distension, and urinary retention. Encourage bowel regimen/hydration; reassess if symptoms develop. Doses may be individualized by the care team.
What happens
An increased risk of paralytic ileus
Interaction Deep Dive
When buprenorphine is given together with an anticholinergic agent, the combination may lead to urinary retention or severe constipation that can progress to paralytic ileus. In patients receiving buprenorphine alongside anticholinergic drugs, watch for indications of urinary retention or diminished gastric motility1.
Why it happens (mechanism)
Additive effects on gastric motility
How to manage this interaction
The goal is to keep your bowels and bladder moving normally while you take both drugs. Your care team can manage this well.
- Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your team may monitor you more closely for constipation, belly swelling, or trouble urinating, and may adjust and individualize your doses if needed.
- Ask your pharmacist whether a stool softener, fiber, or extra fluids could help.
- Contact your pharmacist or doctor promptly if you have no bowel movement for several days, severe bloating or belly pain, nausea and vomiting, or difficulty passing urine.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Glycopyrrolate and Buprenorphine together?
Taking buprenorphine with glycopyrrolate can add up to cause severe constipation or urinary retention, and rarely a stalled bowel (paralytic ileus). Keep taking both as prescribed and tell your care team right away if you have bad constipation, belly bloating, or trouble urinating. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Glycopyrrolate 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 Glycopyrrolate and Buprenorphine interaction managed?
The goal is to keep your bowels and bladder moving normally while you take both drugs. Your care team can manage this well. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your team may monitor you more closely for constipation, belly swelling, or trouble urinating, and may adjust and individualize your doses if needed. Ask your pharmacist whether a sto… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Glycopyrrolate 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 (1)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
Keep reading about Buprenorphine
Keep reading about Glycopyrrolate
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