Suboxone (buprenorphine/naloxone) is a brand-name prescription drug used to treat dependence on opioid drugs. This is also known as opioid use disorder. As with other medications, Suboxone can interact with alcohol and certain other drugs. It can also interact with some supplements and foods. An interaction occurs when one substance causes another substance to have a different effect than expected.

Before you start taking Suboxone, your doctor or pharmacist will advise you on what not to take with Suboxone. For more about Suboxone’s interactions, keep reading. For additional information about Suboxone, including details about what it’s prescribed for, see this article.

Sometimes factors or conditions could prevent your doctor from prescribing Suboxone due to the risk of harm. These are known as contraindications. The contraindications of Suboxone include:

Having had an allergic reaction to Suboxone or any of its ingredients

If you have had an allergic reaction to Suboxone or any of its ingredients, your doctor will likely not prescribe Suboxone. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Suboxone, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Suboxone.

Your doctor will likely recommend that you do not drink alcohol while you’re taking Suboxone. They’ll also usually advise you not to take any prescription or over-the-counter drugs that contain alcohol during Suboxone treatment.

Consuming alcohol and taking Suboxone may cause serious side effects, including:

  • difficulty breathing
  • sleepiness
  • decreased awareness
  • coma

The combination of alcohol and Suboxone may also, in some cases, lead to death. If you have concerns about avoiding alcohol while you’re taking Suboxone, talk with your doctor before starting treatment.

Before you start treatment with Suboxone, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. They can also advise you on what medications you cannot take with Suboxone.

Here’s a chart of drugs that can interact with Suboxone. Keep in mind that this chart doesn’t include all drugs that may interact with Suboxone. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Drug type or drug nameDrug examplesInteraction result with Suboxone
benzodiazepinesdiazepam (Valium)
• alprazolam (Xanax)
• lorazepam (Ativan)
can increase the risk of side effects of Suboxone* and benzodiazepines
sedatives• zolpidem (Ambien, Ambien CR)
• suvorexant (Belsomra)
• eszopiclone (Lunesta)
can increase the risk of side effects of Suboxone* and sedatives
muscle relaxers• cyclobenzaprine (Amrix)
• metaxalone (Skelaxin)
baclofen
can increase the risk of side effects of Suboxone* and muscle relaxers
antipsychoticsquetiapine (Seroquel)
• aripiprazole (Abilify)
olanzapine (Zyprexa)
can increase the risk of side effects of Suboxone* and antipsychotics
opioidsmethadone (Methadose)
oxycodone (Roxicodone)
• hydrocodone (Hysingla ER)
can increase the risk of side effects of Suboxone* and opioids
CYP3A4 blockers• erythromycin (Eryc)
• ketoconazole (Nizoral)
• ritonavir (Norvir)
can increase the risk of side effects of Suboxone*
CYP3A4 inducers• rifampin (Rimactane)
carbamazepine (Tegretol)
phenytoin (Dilantin)
can decrease the effectiveness of Suboxone*
selective serotonin reuptake inhibitors (SSRIs)escitalopram (Lexapro)
• fluoxetine (Prozac)
• paroxetine (Paxil)
can increase the risk of side effects of Suboxone* and SSRIs
serotonin- norepinephrine reuptake inhibitors (SNRIs)• desvenlafaxine (Pristiq)
• duloxetine (Cymbalta)
• venlafaxine (Effexor XR)
can increase the risk of side effects of Suboxone* and SNRIs
tricyclic antidepressants (TCAs)amitriptyline
nortriptyline (Pamelor)
doxepin (Silenor)
can increase the risk of side effects of Suboxone* and TCAs
triptans• frovatriptan (Frova)
• eletriptan (Relpax)
• sumatriptan (Imitrex)
can increase the risk of side effects of Suboxone* and triptans
monoamine oxidase inhibitors (MAOIs)• isocarboxazid (Marplan)
• tranylcypromine (Parnate)
• selegiline (Emsam)
can increase the risk of side effects of Suboxone* and MAOIs
certain allergy medications called antihistamines• diphenhydramine (Benadryl)
hydroxyzine (Vistaril)
• doxylamine (Unisom)
can increase the risk of side effects of Suboxone* and antihistamines
certain treatments for nerve paingabapentin (Neurontin)
• pregabalin (Lyrica)
can increase the risk of side effects of Suboxone* and certain treatments for nerve pain
certain stimulant drugs• amphetamine salts (Adderall)
methylphenidate (Ritalin)
• lisdexamfetamine (Vyvanse)
can increase the risk of side effects of both Suboxone* and certain stimulant drugs
anticholinergic drugs• fesoterodine (Toviaz)
oxybutynin (Ditropan XL)
• tolterodine (Detrol LA)
can increase the risk of side effects of Suboxone* and anticholinergics
drugs that can affect your heart rhythm• atomoxetine (Strattera)
clarithromycin
amiodarone
• vardenafil (Levitra)
can increase the risk of side effects of Suboxone* and drugs that can affect your heart rhythm
diureticsfurosemide (Lasix)
spironolactone (Aldactone)
hydrochlorothiazide (Microzide)
can increase the risk of side effects of Suboxone* and diuretics
certain HIV medications• atazanavir (Reyataz)
• ritonavir (Norvir)
can increase the risk of side effects of Suboxone*
mirtazapine (Remeron)can increase the risk of side effects of Suboxone* and mirtazapine
trazodonecan increase the risk of side effects of Suboxone* and trazodone
ondansetron (Zofran)can increase the risk of side effects of Suboxone* and ondansetron
buspironecan increase the risk of side effects of Suboxone* and buspirone
dextromethorphan (Delysm)can increase the risk of side effects of Suboxone* and dextromethorphan
naltrexone (Vivitrol)may cause opioid withdrawal

* To learn more about the side effects of Suboxone, see this article.
† A brand-name version of buspirone called Buspar used to be available but has been discontinued.

Here’s a closer look at certain drug interactions of Suboxone.

Naltrexone

Naltrexone (Vivitrol) is a medication that’s used to treat alcohol use disorder and opioid use disorder.

Interaction result. Taking Suboxone in combination with naltrexone may cause opioid withdrawal.

Interaction explained. To understand this interaction, it helps to know how Suboxone works. Suboxone contains two active drugs: buprenorphine and naloxone.*

Buprenorphine is a type of medication called an opioid partial agonist-antagonist. This means it partially attaches to opioid receptors (binding sites) and lightly activates them. Because this process is similar to how opioids work, buprenorphine helps decrease opioid cravings in people receiving Suboxone to treat opioid dependence. Also, this partial binding lessens the symptoms of opioid withdrawal.

Naltrexone is an opioid blocker. It strongly attaches to opioid receptors, preventing opioids (including buprenorphine) from binding. As a result, Suboxone won’t work if naltrexone is in your system. The interaction may lead to increased opioid cravings and opioid withdrawal symptoms.

Withdrawal can occur when your body is used to a medication, and then you stop taking it. Or, in this case, your body is used to a medication, and then another drug blocks it from working.

Symptoms of opioid withdrawal can include nausea, headache, sweating, and anxiety.

* Naloxone is a type of medication called an opioid blocker. However, it has an effect only when it’s injected and not when it’s taken orally. Naloxone is added to Suboxone to discourage people from misusing the drug by injecting it.

Steps you or your doctor may take. To avoid this interaction, your doctor will likely recommend either:

  • not taking Suboxone and naltrexone at the same time or
  • not taking Suboxone and naltrexone within a certain time of each other

Before starting treatment with Suboxone, tell your doctor if you’re taking naltrexone.

In some cases, your doctor may have you switch from Suboxone to naltrexone. If they prescribe this, your doctor will likely recommend stopping Suboxone treatment for 1 to 2 weeks before starting to take naltrexone.

You can talk with your doctor about the best treatment plan for you.

Opioids

Opioids are medications that are usually prescribed to treat pain.

Interaction result. Taking Suboxone and an opioid may increase the risk of side effects from both Suboxone and the opioid. (To learn more about the side effects of Suboxone, see this article.)

Interaction explained. Suboxone contains the drug buprenorphine, which works similarly to opioids. Drugs that work in a similar way may cause the same side effects. Both Suboxone and opioids can cause serious side effects such as breathing problems, sedation (sleepiness), and coma. In some cases, the effects may be life threatening. Taking Suboxone with an opioid may further increase the risk of these side effects.

Suboxone also contains another drug called naloxone, which is an opioid blocker.*

Examples of opioid drugs. Here are some opioids that may interact with Suboxone:

Steps you or your doctor may take. Before you start treatment with Suboxone, tell your doctor if you’re taking any opioid drugs.

If you feel you need pain medication while you’re taking Suboxone, talk with your doctor. Due to the risks mentioned above, they’ll likely recommend a drug that is not an opioid.

If you have additional questions about the interaction between opioids and Suboxone, talk with your doctor or pharmacist.

* Naloxone has an effect only when injected and not when it’s taken orally. Naloxone is added to Suboxone to discourage people from misusing the drug by injecting it.

Buspirone

Buspirone is a medication that’s used to treat anxiety.

Interaction result. Taking Suboxone with buspirone may increase the risk of a serious condition known as serotonin syndrome.

Interaction explained. Both Suboxone and buspirone can increase the levels of a chemical in your body called serotonin. The combination of these drugs may raise serotonin to unsafe levels. This can increase your risk of serotonin syndrome.

Steps you or your doctor may take. Before starting treatment with Suboxone, tell your doctor if you’re taking buspirone. If you are, they may monitor you for serotonin syndrome more frequently than usual.

Your doctor will also likely want you to watch for symptoms of serotonin syndrome. These may include nausea, rapid heart rate, hallucinations, and muscle spasms. If you develop any of these symptoms, it’s important to immediately see your doctor or seek emergency treatment.

Suboxone may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Suboxone.

Suboxone interactions with supplements

Before you start treatment with Suboxone, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

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

Suboxone interactions with herbs

There are no specific reports of herbs interacting with Suboxone. However, it’s possible that interactions with herbs could be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Suboxone treatment.

Suboxone and vitamins

There are no specific reports of vitamins interacting with Suboxone. However, it’s possible that interactions with vitamins could be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Suboxone.

Suboxone interactions with food

It’s possible for certain foods and drinks to interact with Suboxone. Your doctor may recommend that you do not consume grapefruit and grapefruit juice while you’re taking the drug. These substances may raise the level of Suboxone in your body. A higher level of the drug can increase your risk of side effects. (To learn more about the side effects of Suboxone, see this article.)

If you’re concerned about any food or drinks interacting with Suboxone, talk with your doctor or pharmacist.

Suboxone and vaccines

Suboxone and vaccines aren’t known to interact with one another. Your doctor and pharmacist can advise you on which vaccines are recommended for you.

Suboxone and lab tests

There aren’t any known interactions between Suboxone and lab tests. If you have any questions about having lab tests during Suboxone treatment, talk with your doctor.

SUBOXONE AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Suboxone. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Suboxone. The impact of cannabis may affect how well you stick to your Suboxone treatment plan.

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

Certain medical conditions and other factors may increase the risk of interactions with Suboxone. Before you take this drug, be sure to talk with your doctor about your health history. Suboxone may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Suboxone include the following.

Allergic reaction. If you’ve had an allergic reaction to Suboxone or any of its ingredients, your doctor will likely not prescribe Suboxone. For details, see “When to avoid Suboxone” above.

Alcohol misuse. If you have alcohol use disorder, your doctor may recommend a treatment other than Suboxone. Drinking alcohol or taking medications that contain alcohol during Suboxone treatment may cause serious side effects that can be life threatening. For details, see “ Suboxone interaction with alcohol” above.

Breathing or lung problems. Before taking Suboxone, tell your doctor about any breathing or lung problems you have. These may include asthma and chronic obstructive pulmonary disorder (COPD).

Suboxone may cause breathing problems. If you already have a condition that affects your breathing, taking the medication may worsen it. Your doctor can determine whether Suboxone is safe for you.

Tooth problems. It’s possible for Suboxone to increase your risk of tooth problems, which may include tooth loss and broken teeth. If you already have a condition that affects your teeth, you may be at an increased risk of this side effect occurring. You can ask your doctor whether Suboxone or a different treatment is right for you.

Adrenal gland problems. Before taking Suboxone, tell your doctor if you have any adrenal gland problems, such as Addison’s disease. The drug may decrease the function of your adrenal glands. If you already have a condition that affects this gland, taking Suboxone can make your condition worse. Your doctor can help determine whether to prescribe Suboxone.

Mental health problems. Suboxone may increase your risk of certain mental health side effects, such as depression or anxiety. If you already have a mental health condition, talk with your doctor. Taking Suboxone may worsen your condition. Your doctor can recommend the right treatment plan for you.

Head injury. Suboxone can increase the pressure in your brain and spinal cord. If you’ve ever had a head injury, talk with your doctor. The increased pressure from Suboxone may make your condition worse. Your doctor can help determine if Suboxone is safe for you.

Pregnancy. It’s not known whether Suboxone is safe to take during pregnancy. However, if the drug is taken during this time, the baby will likely be born with a condition called neonatal opioid withdrawal syndrome. This condition can cause irritability, sleeping problems, and excessive crying in newborns. To learn more, see this article.

If you’re pregnant or planning a pregnancy, talk with your doctor. They may recommend a treatment other than Suboxone. It’s important to treat opioid use disorder before or during pregnancy. If the disorder is left untreated, it may harm the fetus by causing problems such as a low birth weight.

Breastfeeding. Suboxone can pass into breast milk. A child who is breastfed may have side effects such as trouble breathing. You can refer to this article to learn more. If you’re breastfeeding or planning to, talk with your doctor before starting Suboxone treatment.

Liver problems. If you have a liver problem, tell your doctor before starting Suboxone treatment.

Your liver works to remove Suboxone from your system. If you have a liver problem, your body may remove naloxone (one of the ingredients in Suboxone) more slowly. This can raise the level of naloxone in your system, which may increase your risk of side effects.*

Suboxone can also cause liver problems. If you already have a liver problem, the medication may worsen your condition.

If you have a liver problem, your doctor will likely check your liver function. This helps determine whether your liver is healthy enough for you to take Suboxone.

* To learn more about the side effects of Suboxone, see this article.

Here are some frequently asked questions about Suboxone and possible interactions.

Is it safe to take Viagra during Suboxone treatment?

Yes, it’s safe to take sildenafil (Viagra) during Suboxone treatment. There aren’t any known interactions between the two drugs. Viagra may be used to treat erectile dysfunction (ED).

However, it’s important to note that a drug similar to Viagra called vardenafil (Levitra) does interact with Suboxone. Both Suboxone and Levitra can affect your heart rhythm. The combination of the two drugs may increase this risk further.

Your doctor can suggest the right ED treatment for you while you’re taking Suboxone.

Does caffeine interact with Suboxone?

Caffeine is not known to interact with Suboxone. It’s likely safe to consume foods and drinks containing caffeine while you’re taking Suboxone. These may include coffee, tea, and chocolate.

If you have concerns about having caffeine while you’re taking Suboxone, talk with your doctor or pharmacist.

Do prednisone and Suboxone interact?

There aren’t any known interactions between prednisone (Rayos) and Suboxone. Prednisone is a corticosteroid medication that can be used to treat many conditions. These can include rheumatoid arthritis, swelling, and breathing problems such as asthma.

To learn more about taking prednisone in combination with Suboxone, talk with your doctor or pharmacist.

Can I take Chantix with Suboxone?

Yes, you can likely take varenicline (Chantix) with Suboxone. Chantix is a medication that’s used to help people stop smoking. There aren’t any known interactions between the two drugs.

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

Are there any interactions between Suboxone and over-the-counter pain medications?

No, there aren’t any known interactions between Suboxone and over-the-counter pain medications. These drugs may include:

It’s important to note that Suboxone can interact with prescription pain medications, such as opioid drugs. An example is oxycodone (Roxicodone). For more information about this interaction, see “Opioids” in “Drug interactions in depth” above.

If you need pain relief while taking Suboxone, you can ask your doctor or pharmacist to recommend a suitable treatment.

You can take certain steps to help prevent interactions with Suboxone. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

  • Let them know if you drink alcohol or use cannabis.
  • Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
  • Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Suboxone label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Suboxone doesn’t come with paperwork, you can ask your pharmacist to print a copy.) If you have questions about this information, ask your doctor or pharmacist.

You can also help prevent interactions with Suboxone by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Suboxone. These resources might help:

  • Overview of Suboxone. For a general overview of Suboxone, you can see this article.
  • Drug comparison. For information about how Suboxone compares with Subutex, methadone, Zubsolv, and more, read this article.

Disclaimer: Medical News Today 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.