Suboxone Interactions: Alcohol, Medications, and Others

Suboxone (buprenorphine/naloxone) is a prescription drug that’s used to treat opioid use disorder in adults. Like other drugs, Suboxone may have interactions.

Some interactions occur because one substance causes another substance to have a different effect than expected. For example, sometimes alcohol, another drug, or a supplement can affect how a drug acts in your body. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Suboxone’s possible interactions, including other medications that you should not take with Suboxone. And for more information about Suboxone, including details about its uses, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Suboxone. In such cases, your doctor may not prescribe Suboxone for you. These are known as contraindications. The list below includes contraindications of Suboxone.

If you’ve had an allergic reaction. If you have had an allergic reaction to Suboxone or any of its ingredients, your doctor likely won’t prescribe Suboxone. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

You should not drink alcohol during your Suboxone treatment. This is become combining alcohol with Suboxone can raise your risk for life threatening side effects. These include:

• respiratory depression (slow, shallow breathing)
• extreme sleepiness
• loss of consciousness
• coma

If you’re concerned about avoiding alcohol while you’re taking Suboxone, talk with your doctor.

Before you start taking Suboxone, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Suboxone interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Suboxone?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The chart below lists drugs that may interact with Suboxone. Keep in mind that this chart does not include all drugs that may interact with Suboxone. For more information about some of these interactions, see the “Drug interactions explained” section below.

Learn more about certain drug interactions that can occur with Suboxone.

Interaction with benzodiazepines

Suboxone can interact with benzodiazepines, which are drugs used to treat anxiety and sleep problems. Benzodiazepines slow activity in your central nervous system. As a result, they can cause some of the same side effects as Suboxone.

Examples of benzodiazepines include:

• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

What could happen

Taking Suboxone with benzodiazepines can raise your risk for life threatening side effects, including

• respiratory depression (slow, shallow breathing)
• extreme sleepiness
• loss of consciousness
• coma

What you can do

Doctors don’t usually prescribe Suboxone with benzodiazepines unless other treatment options aren’t right for you. If your doctor prescribes these medications together, they’ll use the lowest possible doses of both drugs and monitor you for side effects.

In particular, your doctor will monitor you for excessive sleepiness and symptoms of respiratory depression, such as confusion and slowed breathing. If you have these side effects, you should get urgent medical care.

These side effects can be reversed with a drug called naloxone (Narcan) nasal spray. As a precaution, your doctor may prescribe this medication for you to keep on hand. You can also request it from a pharmacy. To find out more about Narcan, talk with your doctor or pharmacist.

Interaction with opioids

Suboxone contains an opioid drug. In general, opioids are used to treat severe pain. Certain opioids are used to treat opioid use disorder.

Suboxone interacts with other opioids, such as:

• hydrocodone (Hysingla ER)
• methadone
• morphine (MS Contin)
• oxycodone (Oxycontin, Xtampza ER, Oxaydo, others)
• tramadol (Ultram, Conzip)

What could happen

Taking Suboxone with other opioids can raise your risk for opioid overdose and life threatening side effects. Examples of these side effects include:

• respiratory depression (slow, shallow breathing)
• extreme sleepiness
• loss of consciousness
• coma

Taking Suboxone with certain other opioids can also raise your risk of can raise your risk of serotonin syndrome. (This is a serious condition caused by a buildup of a chemical called serotonin in your body.)

Opioids that can cause this side effect if taken with Suboxone include fentanyl (Fentora, Abstral, others) and tramadol (Ultram, Conzip).

Suboxone can also block some of the effects of other opioids. If you take Suboxone with opioid pain relievers, it can make the pain reliever less effective. And if you’re dependent on other opioids, especially methadone, taking Suboxone before the effects of the other opioid have worn off can cause opioid withdrawal symptoms.

What you can do

You shouldn’t start taking Suboxone for opioid use disorder until the effects of other opioids have worn off. Your doctor won’t prescribe Suboxone and methadone together at the same time for opioid use disorder. You shouldn’t mix Suboxone with methadone because this may cause opioid withdrawal symptoms.

While taking Suboxone, you shouldn’t take other opioids unless your doctor prescribes them to relieve pain.

If you take Suboxone with other opioids for pain, your doctor will prescribe the lowest possible dose of both drugs. And they’ll monitor you for side effects. In particular, they’ll monitor you for excessive sleepiness and symptoms of respiratory depression, such as confusion and slowed breathing. If you have these side effects, you should get urgent medical help.

While you’re taking Suboxone, your doctor will likely recommend keeping a drug called naloxone (Narcan) nasal spray on hand as a precaution. Narcan reverses the effects of opioids and is used to treat opioid overdose. To find out more about Narcan, talk with your doctor or pharmacist.

Interaction with sedating antihistamines

Suboxone interacts with sedating antihistamines. These are antihistamines that cause sleepiness. Some of these drugs are allergy medicines, while others are used for motion sickness or other conditions. Many sedating antihistamines can be bought over the counter.

You shouldn’t take sedating antihistamines with Suboxone. Examples of these drugs include:

• chlorpheniramine
• dimenhydrinate (Gravol, Dramamine)
• diphenhydramine (Benadryl)

What could happen

Taking Suboxone with sedating antihistamines can raise your risk of life threatening side effects. Examples of these side effects include:

• respiratory depression (slow, shallow breathing)
• extreme sleepiness
• loss of consciousness
• coma

What you can do

If you need a medication for motion sickness or allergies, ask your doctor or pharmacist to recommend another drug that’s safe for you to take with Suboxone. For example, they may recommend using a non-sedating antihistamine such as loratadine (Claritin) or cetirizine (Zyrtec allergy).

Suboxone may have other interactions. They could occur with food, supplements, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Suboxone.

Does Suboxone interact with food?

You shouldn’t eat grapefruit or drink grapefruit juice while taking Suboxone. Consuming grapefruit may block the breakdown of Suboxone in your body. This could raise your risk of side effects with Suboxone.

If you have questions about consuming other foods or drinks during your treatment with Suboxone, talk with your doctor.

Does Suboxone interact with supplements?

Before you start taking Suboxone, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

Certain supplements can interact with Suboxone. For example, taking Suboxone with certain supplements can raise your risk of serotonin syndrome.

Serotonin syndrome is a serious condition caused by a buildup of a chemical called serotonin in your body. Examples of supplements that may raise your risk of this side effect include:

• 5HTP
• tryptophan

Using the supplement garcinia during your Suboxone treatment may also raise your risk for serotonin syndrome. Your doctor will likely have you stop taking Garcinia during your treatment with Suboxone.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Suboxone interactions with herbs

Certain herbs can interact with Suboxone. Talk with your doctor or pharmacist before using any herbs with this drug.

St. John’s wort can cause your body to break down Suboxone too quickly, which may make Suboxone less effective. It can also raise your risk for a serious side effect called serotonin syndrome.

If you take St. John’s wort, be sure to tell your doctor before starting Suboxone. They’ll likely have you stop taking St. John’s wort during your Suboxone treatment.

Herbs that cause sleepiness may also interact with Suboxone. Taking Suboxone with one of these may cause excessive sleepiness. Before starting Suboxone treatment, tell your doctor if you take any of the following herbs:

• chamomile
• kava
• valerian

Your doctor will determine if it’s safe to continue to take these herbs during your Suboxone treatment.

Suboxone and vitamins

There are currently no reports of Suboxone interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Suboxone.

Does Suboxone interact with vaccines?

No vaccines have been reported to interact with Vyvanse. For more information about getting certain vaccines while you take Suboxone, talk with your doctor.

Does Suboxone interact with lab tests?

Suboxone hasn’t been reported to interact with lab tests. If you’re interested in learning more about having certain lab tests during Suboxone treatment, talk with your doctor.

Does Suboxone interact with cannabis or CBD?

There are currently no reports of Suboxone interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Suboxone.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Suboxone. Before taking Suboxone, talk with your doctor about your health history. They’ll determine whether Suboxone is right for you.

Health conditions or other factors that might interact with Suboxone include:

Breathing problems. Suboxone may cause respiratory depression, especially if used with alcohol, other opioids, or benzodiazepine drugs. Respiratory depression is more likely to be severe if you already have a breathing problem, such as chronic obstructive pulmonary disease (COPD) or sleep apnea.

As a precaution, your doctor may recommend keeping naloxone (Narcan) nasal spray on hand in case you have respiratory depression. Narcan reverses the effects of Suboxone. To find out more about Narcan, talk with your doctor or pharmacist.

Recent head or brain injury. Suboxone can increase the pressure in your brain and spinal cord. This can be dangerous if you have a head or brain injury. Suboxone can alsoshrink your pupils and make you sleepy. If you have a head or brain injury, this can make it harder for your doctor to monitor your condition. Talk with your doctor about whether Suboxone is right for you.

Underactive adrenal glands. Suboxone may cause problems with your adrenal glands, which make and release hormones. If your adrenal glands aren’t currently producing enough hormones, Suboxone could make this problem worse. Talk with your doctor about whether Suboxone is right for you.

Liver problems. Suboxone may cause liver problems, such as liver inflammation and liver failure. If you already have a liver problem, Suboxone could make your condition worse.

In addition, Suboxone may be less effective at preventing opioid withdrawal symptoms if you have a liver problem. If you have liver problems, talk with your doctor about whether Suboxone is right for you.

Your doctor may order blood tests to check your liver function while you take Suboxone.

Gallbladder problems. If you have a problem with your gallbladder, Suboxone could make it worse. Talk with your doctor about whether Suboxone is right for you.

Pregnancy. Taking Suboxone during pregnancy can cause a condition called neonatal opioid withdrawal syndrome in a baby after birth. Suboxone can also reduce the effectiveness of opioid pain medications that may be used during labor and delivery.

Doctors usually recommend medications other than Suboxone for treating opioid use disorder during pregnancy. Your doctor can tell you about other medications that may be better options during your pregnancy.

Breastfeeding. Suboxone passes into breast milk in small amounts, but it’s usually considered safe to take while breastfeeding. If you’re breastfeeding or planning to breastfeed, talk with your doctor before starting Suboxone treatment.

If you do breastfeed while taking Suboxone, you should watch your child for possible side effects. These may include excessive sleepiness, trouble breathing, and not gaining enough weight.

Allergic reaction. If you’ve had an allergic reaction to Suboxone or any of its ingredients, your doctor will likely not prescribe Suboxone. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Find answers to some frequently asked questions about Suboxone and possible interactions.

Is it safe to take Suboxone and Viagra together?

Sildenafil (Viagra) is a drug used to treat erectile dysfunction. Suboxone hasn’t been reported to interact with Viagra. But you should talk with your doctor before using these medications together. Both drugs may cause dizziness when standing up. So, you may be more likely to have this side effect if you take them together.

Are there interactions between prednisone and Suboxone?

Prednisone (Rayos) is a corticosteroid that’s used to reduce inflammation (swelling) caused by many different conditions. No interactions have been reported between prednisone and Suboxone. But in some cases, taking prednisone for long periods of time can prevent your adrenal glands from producing enough of certain hormones. Long-term use of Suboxone may also cause this side effect.

Before taking Suboxone with prednisone, talk with your doctor to see if it’s safe to do so.

Does ibuprofen interact with Suboxone?

Ibuprofen (Advil, Motrin) is a pain reliever that also reduces inflammation (swelling). It hasn’t been reported to interact with Suboxone. It’s generally considered safe to take these medications together.

If you have other questions about taking ibuprofen with Suboxone, talk with your doctor or pharmacist.

Are there interactions between Chantix and Suboxone?

Varenicline (Chantix) is a medication used to help with quitting smoking. No interactions have been reported between Chantix and Suboxone. But these drugs can cause some similar side effects, such as nausea, headache, and insomnia (trouble sleeping). If you take Chantix and Suboxone together, you may be more likely to have these side effects.

If you’re interested in taking Chantix and Suboxone together, talk with your doctor.

Taking certain steps can help you avoid interactions with Suboxone. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Suboxone treatment.

It’s also important to read Suboxone’s label and other paperwork that may come with the drug. You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Suboxone, ask your pharmacist to print a copy for you.) If you need help understanding this information, your doctor or pharmacist can help.

Taking Suboxone exactly as prescribed can also help prevent interactions.

If you still have questions about Suboxone and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Does my risk of interactions depend on my dosage of Suboxone?
• Could I take Suboxone even if I have asthma?
• Do other drugs for opioid use disorder have similar interactions?
• Do you recommend keeping Narcan on hand while I’m taking Suboxone?

To learn more about Suboxone, see these articles:

• Suboxone (buprenorphine and naloxone)
• Sublocade vs. Suboxone: What You Should Know

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.