Meprobamate 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
Meprobamate
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.
Let me explain this one, because it's important. Buprenorphine (found in Suboxone, Belbuca, and others) is an opioid, and meprobamate is an older medicine used for anxiety. Both slow down your brain and your breathing. When you take them together, those effects add up. That can lead to heavy drowsiness, very slow or shallow breathing, and in serious cases, unresponsiveness.
The good news is that your care team can manage this safely. They may keep your doses as low as possible, watch you more closely, or look at other options. Please don't stop either medicine on your own. Just talk with your doctor or pharmacist so they can tailor your plan.
Effect: Additive CNS and respiratory depression. Buprenorphine (opioid partial agonist) plus meprobamate (a sedative carbamate) produce overlapping pharmacodynamic depression of the CNS. This is a PD interaction, not enzyme-mediated; neither agent's activation is relevant here.
- Direction: Increased sedation, profound sedation, respiratory depression, risk of coma/death.
- Severity: Major. Evidence: Probable (supported by epidemiologic MAT/overdose data). Onset: Unspecified.
Management: Cessation of the CNS depressant is preferred; consider taper to lowest effective dose or alternative anxiety therapy. If combined, monitor for respiratory depression and consider a higher level of care. Do not withhold MAT solely because of concurrent CNS depressant use.
What happens
An increased risk of respiratory depression and CNS depression
Interaction Deep Dive
When buprenorphine is given together with a CNS depressant, the CNS depressant effects can be additive, raising the likelihood of respiratory depression, deep sedation, coma, and death. Discontinuing the CNS depressant is favored rather than using the two agents together. Depending on the situation, it may be suitable to observe the patient at a higher level of care or to pursue a taper. In other situations, it may be appropriate to gradually withdraw the patient from a prescribed CNS depressant or to reduce it to the lowest dose that remains effective. When the two must be used together, exercise caution in monitoring and management, and think about alternative treatments for insomnia or anxiety2. 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) face a heightened risk of death. An analysis of pooled nationwide death certificate data spanning 2010 to 2014 showed that most overdose deaths involving buprenorphine and methadone also involved concurrent CNS depressant use. Whether buprenorphine and methadone differ in the risk of overdose death when combined with CNS depressant drugs is not known 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
This combination adds up two sedating medicines, so your team will manage it carefully.
- Keep taking both as prescribed unless your prescriber tells you otherwise. Do not stop either one on your own.
- Your team may prefer to reduce or gradually taper the meprobamate to the lowest effective dose, or consider a different treatment for anxiety.
- They may monitor you more closely, and in some cases watch you in a higher level of care.
- Get emergency help for very slow or shallow breathing, extreme drowsiness, confusion, or trouble waking.
Raise this with your pharmacist or prescriber so your doses can be adjusted and individualized to keep you safe.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) An epidemiological investigation conducted in Sweden found 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) had a heightened risk of death. Over the interval from July 1, 2005 to December 31, 2012, researchers examined the risk of fatal overdose, non-overdose related mortality, and all-cause mortality in MAT-treated patients (aged 18 to 50), comparing periods when CNS depressants were prescribed with periods without CNS depressant therapy. The findings showed an increased 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 regarded as statistically significant. Although the results indicated a raised risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods of coadministration of 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 of use for the drugs 3.
b) A study drawing on aggregate nationwide death certificate data spanning 2010 to 2014 recorded 3495 drug overdose deaths in 2014. Methadone together with other CNS depressants were commonly cited as contributors to those deaths. Concurrent ALPRAZolam use appeared in 18.1% of cases, followed by oxyCODONE (10.1%), cocaine (9.6%), heroin (9%), and diazePAM (6.6%). The FDA documented 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 count 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 remains unknown 3.
Common questions
Can I take Meprobamate and Buprenorphine together?
Taking buprenorphine and meprobamate together adds up their sedating effects and raises the risk of dangerously slow breathing and heavy sedation. Keep taking both as prescribed and talk with your care team, who can lower doses, monitor you more closely, or consider safer options. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Meprobamate 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 Meprobamate and Buprenorphine interaction managed?
This combination adds up two sedating medicines, so your team will manage it carefully. Keep taking both as prescribed unless your prescriber tells you otherwise. Do not stop either one on your own. Your team may prefer to reduce or gradually taper the meprobamate to the lowest effective dose, or consider a different treatment for anxiety. They may monitor you more closely, and in some cases watch… 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 Meprobamate 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 Meprobamate
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