Suboxone Drug Interactions

Suboxone should not be taken together with alcoholic drinks or medications containing alcohol, as alcohol increases the sedative effect of buprenorphine (see Effects on the Ability to Drive or Operate Machinery under Precautions).
Suboxone should be used cautiously when co-administered with: Benzodiazepines: This combination may result in death due to respiratory depression of central origin. Therefore, dosages must be limited and this combination must be avoided in cases where there is a risk of misuse (see Precautions).
Other central nervous system depressants, other opioid derivatives (eg, methadone, analgesics and antitussives), certain antidepressants, sedative H₁-receptor antagonists, barbiturates, anxiolytics other than benzodiazepines, neuroleptics, clonidine and related substances: These combinations increase central nervous system depression. The reduced level of alertness can make driving and using machines hazardous.
CYP3A4 Inhibitors: An interaction study of buprenorphine with ketoconazole (a potent inhibitor of CYP3A4) resulted in increased C_max and area under the curve (AUC) of buprenorphine (approximately 70% and 50%, respectively) and to a lesser extent, of norbuprenorphine. Patients receiving Suboxone should be closely monitored and may require dose reduction if combined with potent CYP3A4 inhibitors (eg, protease inhibitors eg, ritonavir, nelfinavir or indinavir or azole antifungals eg, ketoconazole or itraconazole).
CYP3A4 Inducers: The interaction of buprenorphine with CYP3A4 inducers has not been investigated. Therefore, it is recommended that patients receiving Suboxone should be closely monitored if inducers (eg, phenobarbital, carbamazepine, phenytoin, rifampicin) are co-administered.
To date, no notable interaction has been observed with cocaine, the agent most frequently used by multi-drug abusers in association with opioids.