The do’s + don’ts of managing other substances while on Suboxone®

Suboxone® can interact with other substances which might make it less effective. Use this quick guide to help you stay safe during your treatment.

Ophelia team
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Whether you’re new to Suboxone® treatment (important safety information) or in an established treatment protocol, it’s important to be sure you’re taking the medication safely and balancing it with your other health needs. Similar to other medications, Suboxone can interact with other substances that might make it less effective or even produce harmful side effects. Use this quick guide to help you stay safe during your treatment. 


Discuss all medications with your doctor

Medication interactions are complicated, and only licensed and qualified medical professionals can give specific advice on what is or isn’t safe. Whether you’re having surgery, trying to relieve allergies, or seeking treatment for an infection or cold, it’s crucial that you consult with your doctor about what medications you can take. Even seemingly innocuous and unrelated drugs, such as antibiotics or antidepressants, can have unexpected interactions with your Suboxone treatment. 

If the doctor prescribing your new medications isn’t the doctor administering your Suboxone regimen, make sure to inform the new physician that you’re undergoing treatment. This will help them avoid prescribing a medication with a known interaction; additionally, consult with your treatment program’s prescribing physician to verify. 

Use OTC medications safely to treat common ailments

If you get sick or need minor pain relief, it’s generally safe to take over-the-counter medications as prescribed to treat your symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen (Advil®), aspirin, and naproxen (Aleve®)—are appropriate for relieving pain, even after surgery, and they don’t have any interactions with the buprenorphine and naloxone found in Suboxone. Acetaminophen (Tylenol®) is also safe to take while on Suboxone and is effective at treating pain. 

When taking these OTC medications, always use them as instructed and never take more than the recommended doses. Doing so can cause adverse reactions when combined with Suboxone.

There are also a few OTC antihistamines that should be avoided while undergoing treatment. The most common is Benadryl®, which contains an active ingredient called diphenhydramine. Although generally safe, this ingredient has a moderate negative interaction with Suboxone and can increase dizziness and drowsiness. Cetirizine, the active ingredient in Zyrtec®, can produce similar side effects.

Dextromethorphan, an ingredient commonly used in cold medications to suppress the cough reflex, has a moderate interaction risk that can affect your blood pressure, heart rate, and stomach. During cold and flu season, look for products labeled as expectorants, which thin out mucus and do not contain dextromethorphan, rather than cough suppressants.

If you have any questions about a medication you usually take for minor pain or illnesses, reach out to your medical provider for information on the safe usage of OTC medicine. 


Mix sedatives with Suboxone

When a person takes opioids of any kind, their body reacts by depressing respiratory function and slowing breathing. This is what makes opioid overdoses so dangerous. While Suboxone utilizes naloxone to reduce these effects, they are still present while undergoing Suboxone treatment. Taking another medication that also depresses the respiratory system has a compounding effect. This means any sedatives you take while on Suboxone will have a more powerful effect than usual, which can lead to difficulty breathing or maintaining consciousness.

This is true of all medications with sedating properties, from antihistamines and antidepressants to other opioids and antipsychotics. If your prescription for one of these medications pre-dates your Suboxone treatment, make sure a doctor is closely monitoring your condition and making adjustments as needed. Quitting one medication immediately can be risky, so do not stop taking any medicines without medical supervision. Inform any doctors who may prescribe new medications that you need to avoid all sedating effects because of your ongoing treatment.

Consume alcohol while on Suboxone

While it is legal, less regulated, more easily accessible, and more socially acceptable than other drugs, alcohol is a depressant and should be avoided while taking Suboxone. Just like sedatives, alcohol can depress the respiratory system, even when consumed in small amounts. This increases drowsiness, dizziness, and fatigue as side effects, and it can put a person at greater risk of overdose. These side effects are particularly dangerous because alcohol can also cause nausea and vomiting.


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