Hydroquinidine 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
Hydroquinidine
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 can affect your heart's rhythm. Buprenorphine (a pain or opioid-treatment medicine) and hydroquinidine (a heart rhythm medicine) can each stretch out a part of your heartbeat called the QT interval. When you take them together, that effect can add up, which in rare cases could lead to an irregular heartbeat.
This is a possible concern based on how the drugs work, not something proven with strong data. The risk is higher if you have things like low potassium or magnesium, a slow heartbeat, or a known heart-rhythm problem. Please don't stop either medicine on your own. Your care team can manage this safely by checking on you and adjusting things as needed.
Mechanism: additive QT interval prolongation. Both agents independently prolong the QT interval; neither is a prodrug and the concern is pharmacodynamic (not PK).
- Direction: combined/additive QTc prolongation, increasing torsades de pointes risk.
- Evidence: theoretical; magnitude of combined risk not quantified.
- Onset: unspecified.
- Management: Manufacturer advises avoiding concomitant use. If co-prescribed, obtain baseline and follow-up ECG, correct electrolytes (K+, Mg2+), and reassess in patients with bradycardia, CHF, digitalis therapy, baseline/congenital QT prolongation, or recent AF conversion.
What happens
An increased risk of QT interval prolongation
Interaction Deep Dive
Buprenorphine should not be taken together with medications capable of prolonging the QT interval342. It remains unknown what risk arises from pairing buprenorphine with other agents that cause QT prolongation. When prescribing buprenorphine to individuals who have risk factors, including hypokalemia, bradycardia, recent conversion from atrial fibrillation, congestive heart failure, digitalis therapy, baseline QT prolongation, subclinical long-QT syndrome, or severe hypomagnesemia, clinicians should factor these considerations into their decisions1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
The main strategy is caution and monitoring. The product guidance is to avoid using these two together when possible, so your care team may consider whether an alternative is a better fit.
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Your team may check an ECG and blood tests for potassium and magnesium, and correct any that are low.
- Tell your care team if you have heart failure, a slow or irregular heartbeat, or a family history of QT problems.
- Report fainting, dizziness, or palpitations promptly.
Your dose and monitoring can be individualized to keep you safe.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Hydroquinidine and Buprenorphine together?
Buprenorphine and hydroquinidine can both prolong the QT interval, so combining them may add to that risk; keep taking both as prescribed and ask your care team whether monitoring or an alternative is right for you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Hydroquinidine 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 Hydroquinidine and Buprenorphine interaction managed?
The main strategy is caution and monitoring. The product guidance is to avoid using these two together when possible, so your care team may consider whether an alternative is a better fit. Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Your team may check an ECG and blood tests for potassium and magnesium, and correct any that are low. Tell your care team if you… 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 Hydroquinidine 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 (4)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
- Product Information: BUTRANS(R) transdermal system patch, buprenorphine transdermal system patch. Purdue Pharma L.P. (per FDA), Stamford, CT, 2016. DailyMed
- Product Information: BELBUCA(TM) buccal film, buprenorphine buccal film. Endo Pharmaceuticals Inc. (per FDA), Malvern, PA, 2016.
- Product Information: BUPRENEX(R) intravenous injection, intramuscular injection, buprenorphine HCl intravenous injection, intramuscular injection. Indivior Inc. (per DailyMed), Richmond, VA, 2016. DailyMed
Keep reading about Buprenorphine
Keep reading about Hydroquinidine
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