Suboxone, a medication composed of buprenorphine and naloxone, is widely used in medication-assisted treatment (MAT) for opioid use disorder. It helps reduce cravings and withdrawal symptoms, aiding individuals in their recovery journey. However, while Suboxone can be a highly effective part of addiction treatment, it is essential to be cautious about what substances you take with it. Certain medications, supplements, or even foods can interfere with Suboxone’s effectiveness or exacerbate its side effects. Some combinations may pose serious risks, including overdose, sedation, or respiratory depression.
Understanding what should not be taken with Suboxone is crucial to ensure its safe and effective use. This guide covers various substances, such as other medications, alcohol, and over-the-counter (OTC) drugs, that should be avoided or taken with caution while on Suboxone.
Alcohol
One of the most significant risks when taking Suboxone is consuming alcohol. Both Suboxone and alcohol act as central nervous system depressants. When taken together, they can have a combined sedative effect, leading to dangerous outcomes such as:
- Increased risk of respiratory depression: Both alcohol and Suboxone can slow down breathing, and when combined, the risk of severe respiratory depression is greatly heightened. This can lead to fatal consequences, especially if large quantities of alcohol are consumed.
- Enhanced sedation: The combination can result in extreme drowsiness or sedation, impairing cognitive and motor functions.
- Overdose risk: Mixing alcohol with Suboxone increases the likelihood of an overdose, as it can intensify the depressant effects of the medication.
To ensure safety, it’s critical to avoid alcohol entirely while taking Suboxone. Even small amounts of alcohol, such as that found in certain medications or foods, can pose risks.
Benzodiazepines
Benzodiazepines are a class of prescription drugs often used to treat anxiety, insomnia, or seizure disorders. Common benzodiazepines include:
- Diazepam (Valium)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
Similar to alcohol, benzodiazepines are central nervous system depressants. When taken with Suboxone, they increase the risk of:
- Respiratory depression: The combined sedative effects of both substances can lead to dangerously slow or shallow breathing.
- Extreme sedation: Individuals may experience overwhelming drowsiness, confusion, or even loss of consciousness.
- Overdose: The risk of overdose is much higher when benzodiazepines are used with Suboxone, especially if either substance is taken in higher doses.
For individuals who require benzodiazepines for legitimate medical conditions, it is crucial to speak with a healthcare provider before using them in combination with Suboxone. Your doctor may need to closely monitor your dosage and symptoms to minimize risks.
Other Opioids
Taking other opioids while on Suboxone is not only counterproductive but also dangerous. Suboxone contains buprenorphine, which is a partial opioid agonist. This means it can provide some opioid-like effects, but to a lesser extent than full opioid agonists such as heroin, oxycodone, or morphine.
When someone takes other opioids while on Suboxone, the buprenorphine component will block the full effects of those opioids due to its high affinity for opioid receptors. This can lead to:
- Diminished effects of the other opioids: Users may not feel the typical “high” they would expect from other opioids.
- Potential overdose: Because Suboxone can block the effects of opioids, some individuals may attempt to take larger amounts of opioids to overcome the blockage, increasing their risk of overdose.
- Increased side effects: Mixing opioids can lead to increased nausea, dizziness, confusion, and respiratory depression.
The naloxone in Suboxone is designed to further discourage misuse of opioids by blocking their euphoric effects when injected. However, individuals trying to use other opioids during Suboxone treatment may find themselves in a dangerous situation with little benefit and high risks.
Sedatives and Sleep Aids
Sedative medications and sleep aids, such as:
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Diphenhydramine (Benadryl)
- Over-the-counter sleep aids
These substances can amplify the sedative effects of Suboxone, increasing the risk of:
- Severe drowsiness: It becomes harder to stay awake, focus, or function normally.
- Respiratory depression: The risk of breathing problems is heightened, especially during sleep.
- Accidents or falls: With increased sedation comes a higher chance of accidents, such as falls or motor vehicle crashes.
If you have trouble sleeping while on Suboxone, it is essential to consult with your healthcare provider to find safe alternatives that will not interact negatively with the medication.
Antidepressants
Certain antidepressants, particularly those that act on serotonin levels, can interact with Suboxone and cause a condition known as serotonin syndrome. This is a potentially life-threatening condition that occurs when there is too much serotonin in the brain. Symptoms of serotonin syndrome include:
- Agitation or restlessness
- Rapid heart rate
- High blood pressure
- Muscle rigidity
- Seizures
Medications that can contribute to serotonin syndrome include:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) or duloxetine (Cymbalta)
- Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil) or nortriptyline (Pamelor)
While these medications are often prescribed to individuals with depression, it is important to have an open discussion with your healthcare provider to manage potential risks and to monitor for signs of serotonin syndrome if you are taking both Suboxone and an antidepressant.
Muscle Relaxants
Muscle relaxants, such as cyclobenzaprine (Flexeril) or carisoprodol (Soma), can also have a sedative effect on the central nervous system. Combining these medications with Suboxone may result in:
- Increased drowsiness: Muscle relaxants may cause extreme fatigue when used with Suboxone.
- Decreased coordination: The combination may impair motor skills and reaction times, which is particularly dangerous when driving or operating heavy machinery.
- Respiratory depression: Like other central nervous system depressants, muscle relaxants can slow breathing when used with Suboxone.
It is best to consult with a healthcare professional before taking any muscle relaxants while on Suboxone to avoid potentially dangerous interactions.
Anti-Anxiety Medications
Anti-anxiety medications, including those in the benzodiazepine family as well as others such as buspirone (Buspar), can increase sedation and respiratory depression when taken with Suboxone. Buspirone, while not a sedative like benzodiazepines, can still interact with Suboxone and exacerbate side effects. It is important to use caution and speak with a healthcare provider about possible alternatives to manage anxiety while undergoing Suboxone treatment.
Certain Over-the-Counter Medications
Over-the-counter (OTC) medications are generally considered safe, but some can still interact with Suboxone. For example:
- Antihistamines like diphenhydramine (found in Benadryl) can increase drowsiness and cause confusion when combined with Suboxone.
- Cold medications containing dextromethorphan can have depressant effects on the nervous system, making the side effects of Suboxone worse.
Always check with a pharmacist or healthcare provider before using any OTC medications alongside Suboxone.
Herbal Supplements
Herbal supplements may seem harmless, but some can interact with Suboxone, especially those known to affect brain chemistry or the nervous system. For example:
- St. John’s Wort, often used for depression, can reduce the effectiveness of Suboxone by altering how it is processed in the liver.
- Kava and valerian root, both used to promote relaxation or sleep, can enhance the sedative effects of Suboxone, increasing the risk of drowsiness and respiratory depression.
Conclusion
While Suboxone is an essential tool in the treatment of opioid addiction, it is important to be aware of potential drug interactions that can jeopardize its safety and effectiveness. Avoiding substances like alcohol, benzodiazepines, opioids, and certain sedatives is critical to minimizing risks, such as respiratory depression, overdose, or extreme sedation. Always consult with a healthcare provider before taking any new medications or supplements while on Suboxone, and be open about all substances you are using to ensure your treatment plan is safe and effective. Call us at 844-639-8371 to learn more.