Oxazepam 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
Oxazepam
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.
Buprenorphine (like Belbuca, Suboxone, or Sublocade) is an opioid, and oxazepam is a benzodiazepine used for anxiety or sleep. Both can slow down your brain and your breathing. When you take them together, those calming effects can add up. That can lead to heavy drowsiness, very slow breathing, and in serious cases loss of consciousness or worse.
This is a serious combination, but it can be managed. Please don't stop either medicine on your own, especially buprenorphine, which treats pain or opioid use disorder. Instead, talk with your doctor or pharmacist. Your care team can adjust doses, watch you more closely, or find a safer option for anxiety or sleep.
Effect: Additive CNS and respiratory depression from combining buprenorphine (partial opioid agonist) with oxazepam (benzodiazepine). Risk includes profound sedation, respiratory depression, coma, and death.
Mechanism: Pharmacodynamic (additive CNS depression), not a metabolic/prodrug interaction. Evidence: Probable; supported by Swedish epidemiologic MAT data and US overdose death-certificate data.
- Cessation of the benzodiazepine is preferred over concomitant use; taper to lowest effective dose if continuation needed.
- Do not withhold MAT (buprenorphine) solely due to CNS depressant use.
- If combined, monitor mental status and respiratory status; consider higher level of care and alternative agents for anxiety/insomnia.
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. Rather than using these agents concurrently, it is preferable to discontinue benzodiazepines or other CNS depressants. Certain situations may call for monitoring within a higher level of care or for a taper. In other situations, it may be suitable to slowly wean a patient off 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 careful management1. A Swedish epidemiological study found that patients undergoing methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for instance, agents used for insomnia) face a heightened risk of death. Based on an analysis of pooled nationwide death certificate records spanning 2010 to 2014, most overdose deaths involving buprenorphine and methadone also involved the concurrent use of a CNS depressant. Whether the risk of fatal overdose with concomitant CNS depressant drugs varied between buprenorphine and methadone is not known 3.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. Do not stop buprenorphine on your own, and do not abruptly stop oxazepam.
Your care team typically manages this by:
- Preferring to reduce or gradually taper the benzodiazepine, or use the lowest effective dose
- Considering non-benzodiazepine options for anxiety or sleep
- Monitoring you more closely, sometimes in a higher level of care
Get emergency help for extreme drowsiness, confusion, slow or shallow breathing, or trouble waking. Ask your pharmacist or prescriber before adding alcohol, sleep aids, or other sedating medicines.
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, medications for insomnia) have an increased risk of death. From July 1, 2005 to December 31, 2012, investigators examined 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 MAT combined with benzodiazepine treatment; however, these data were not deemed statistically significant. Although the results showed an elevated 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. A comparison between the benzodiazepine cohort and the non-benzodiazepine cohort was not performed because the authors did not adjust for the indication for which the drugs were used 3.
b) According to a study of aggregate 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 in those deaths. Concurrent alprazolam use 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 involving buprenorphine. Of 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. It remains unknown whether the risk of overdose death with concomitant CNS depressant drugs differed between buprenorphine and methadone 3.
Common questions
Can I take Oxazepam and Buprenorphine together?
Combining buprenorphine and oxazepam adds up their sedating effects and can dangerously slow breathing, so keep both as prescribed and have your care team manage the doses and monitor you closely. Never stop either medicine on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Oxazepam 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 Oxazepam and Buprenorphine interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. Do not stop buprenorphine on your own, and do not abruptly stop oxazepam. Your care team typically manages this by: Preferring to reduce or gradually taper the benzodiazepine, or use the lowest effective dose Considering non-benzodiazepine options for anxiety or sleep Monitoring you more closely, sometimes in a highe… 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 Oxazepam 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 Oxazepam
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