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Database of Antiretroviral Drug Interactions

Interactions with Buprenorphine (Suboxone) and Antiretrovirals

Antiretroviral (ARV)Dose of ARVDose of BuprenorphineEffect on ARV LevelsEffect on Buprenorphine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Darunavir543, 541
(DRV)(Prezista)
600 mg BID with ritonavir 100 mg BID8-16 mg-Norbuprenorphine AUC: increased 46%; Cmin: increased 71%; Cmax: increased 36%-Inhibition of P450 3A4 by darunavir/ritonavir

No dose adjustment necessary

Didanosine441
(ddI)(Videx)
400 mg QD16 mg QD- No significant change- -

No dose adjustment necessary

Efavirenz289
(EFV)(Sustiva)
600 mg QD x 15 dstable dose for at least 2 weeksNo significant changeBuprenorphine AUC: decreased 49%; Cmax: decreased 45%, Cmin: decreased 50%; half-life: decreased 29%Possible decreased buprenorphine effects-

Monitor for signs and symptoms of opioid withdrawal; some patients may need an increase in the buprenorphine dose, though study patients did not go into opioid withdrawal

Elvitegravir/cobicistat727
(Genvoya, Stribild)
--Tipranavir/ritonavir Cmin decreased 19-40%Norbuprenorphine AUC decreased 80%Possible decreased buprenoprhine effects. Possible loss of antiviral efficacy with tipranavir/ritonavir.-

Monitor viral load and consider monitoring tipranavir level

Elvitegravir/cobicistat625
(Genvoya, Stribild)
-16-24 mg with 4-6 mg naloxoneNo significant changeBuprenorphine AUC; increased 35%; Cmin: increased 66%; Norbuprenorphine AUC: increased 42%; Cmax: increased 24%; Cmin: increased 57%. Naloxone: no significant change.--

No dose adjustment necessary

Antiretroviral (ARV)Dose of ARVDose of BuprenorphineEffect on ARV LevelsEffect on Buprenorphine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Lamivudine442
(3TC)(Epivir)
300 mg QD14 mg QD-No significant change--

No dose adjustment necessary

Lopinavir/ritonavir453
(LPV/r)(Kaletra)
Lopinavir/ritonavir 800 mg/200 mg QDpaitents on stable buprenorphine/naloxoneLopinavir Cmax: decreased 22-32% (when compared to historical controls)Buprenorphine: no significant change; Norbuprenorphine Cmax: decreased 41%No significant change-

No dose adjustment necessary

Raltegravir575
(RAL)(Isentress)
400 mg BIDstable dose for at least 3 weeksNo significant changeNo significant change--

No dose adjustment necessary

Tenofovir disoproxil fumarate443
(TDF)(Viread)
300 mg QD16 mg QD-No significant change--

No dose adjustment necessary

Zidovudine288
(AZT, ZDV)(Retrovir)
- - No significant change- - -

No dose adjustment necessary

"-" indicates that there are no data available
 288:McCance-Katz EF, Rainey PM, Friedland G, et al. Effect of opioid dependence pharmacotherapies on zidovudine disposition. Am J Addict 2001;10:296-307.
 289:McCance-Katz E, Pade P, Friedland G, et al. Efavirenz decreases buprenorphine exposure, but is not associated with opiate withdrawal in opiod dependent individuals [abst. #653]. 12th Conference on Retroviruses and Opportunistic Infections; 2005 February 22-25; Boston, Massachusetts.
 441:Gruber VA, Baker J, Moody DE, et al. Interactions between buprenorphine and antiretrovirals: nucleos(t)ide reverse transcriptase inhibitors didanosine, lamivudine and tenofovir [abstract A1-1306]. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2009 September 12-15; San Francisco, California.
 442:Gruber VA, Baker J, Moody DE, et al. Interactions between buprenorphine and antiretrovirals: nucleos(t)ide reverse transcriptase inhibitors didanosine, lamivudine and tenofovir [abstract A1-1306]. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2009 September 12-15; San Francisco, California.
 443:Gruber VA, Baker J, Moody DE, et al. Interactions between buprenorphine and antiretrovirals: nucleos(t)ide reverse transcriptase inhibitors didanosine, lamivudine and tenofovir [abstract A1-1306]. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2009 September 12-15; San Francisco, California.
 453:Bruce RD, Altice FL, Moody DE, et al. Pharmacokinetic interactions between buprenorphine/naloxone and lopinavir/ritonavir [abstract 620]. 17th Conference on Retroviruses and Opportunistic Infections; 2010 Feb 16-18; San Francisco, California.
 541:Prezista [package insert]. Raritan, NJ: Tibotec Therapeutics Inc.; December 2010.
 543:Sekar V, Tomaka F, Lefebvre E, et al. Pharmacokinetic interactions between darunavir/ritonavir and opioid maintenance therapy using methadone or buprenorphine/naloxone. J Clin Pharmacol 2010; 1-8. Epub ahead of print.
 575:Bruce RD, Moody K, Chodkowski D, et al. Pharmacokinetic interactions between buprenorphine/naloxone and raltegravir [MOPE176]. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 17-20 July, 2011; Rome, Italy.
 625:Bruce R, Winkle P, Custodio J, et al. Pharmacokinetics of cobicistat-boosted elvitegravir administered in combination with methadone or buprenorphine/naloxone [poster A-1250]. 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy Sept 9-12, 2012. San Francisco, CA.
 727:Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.