Can oxycodone (OxyContin) and Suboxone (buprenorphine/naloxone) be taken together?

Oxycodone and Suboxone Should Not Be Taken Together

Oxycodone and Suboxone (buprenorphine/naloxone) should not be taken together as this combination can lead to precipitated withdrawal, reduced analgesic effects, and potentially life-threatening respiratory depression.

Pharmacological Interactions

Mechanism of Interaction

• Buprenorphine (in Suboxone) is a partial mu-opioid receptor agonist with high binding affinity
• Oxycodone is a full mu-opioid receptor agonist with lower binding affinity
• When taken together:
  • Buprenorphine will displace oxycodone from receptors
  • This can precipitate withdrawal in opioid-dependent individuals
  • The naloxone component in Suboxone adds further antagonist effects

FDA Label Warning

The FDA label for oxycodone specifically warns against concomitant use with mixed agonist/antagonist opioid analgesics like buprenorphine 1:

• "May reduce the analgesic effect of oxycodone hydrochloride tablets and/or may precipitate withdrawal symptoms"
• "Avoid concomitant use"

Clinical Consequences

Reduced Efficacy

• Buprenorphine will block oxycodone's analgesic effects due to its higher receptor affinity
• This creates a situation where the patient experiences:
  • Diminished pain relief from oxycodone
  • Potential withdrawal symptoms
  • Risk of taking higher oxycodone doses to overcome the blockade

Safety Concerns

• Respiratory depression risk increases with attempts to overcome buprenorphine blockade by taking higher oxycodone doses 2
• The Mayo Clinic Proceedings guidelines specifically list buprenorphine as a medication that should not be combined with full mu-opioid agonists 2
• Attempting to use both medications can lead to:
  • Withdrawal symptoms
  • Inadequate pain control
  • Respiratory depression
  • Sedation

Appropriate Clinical Approaches

For Patients on Suboxone Needing Pain Management

1. Maintain Suboxone therapy if the patient is stable on it for opioid use disorder

2. Consider non-opioid pain management options:

   • NSAIDs if not contraindicated
   • Acetaminophen
   • Adjuvant analgesics (gabapentinoids, SNRIs)
   • Physical therapy and non-pharmacological approaches

3. For severe acute pain requiring opioids:

   • Consult with addiction medicine/pain specialist
   • May require temporary adjustment of buprenorphine dosing
   • Higher doses of full opioid agonists may be needed under close supervision

For Patients on Oxycodone Considering Suboxone

• Complete discontinuation of oxycodone is required before initiating Suboxone
• Patient must be in mild-moderate withdrawal before starting Suboxone to avoid precipitated withdrawal
• Typical waiting period after last oxycodone dose: 12-24 hours

Special Considerations

Unique Formulations

While standard oxycodone and Suboxone should not be combined, there are specific formulations designed for concurrent use:

• Prolonged-release oxycodone/naloxone combinations have been developed specifically to reduce opioid-induced bowel dysfunction while maintaining analgesia 2, 3
• These are different from taking separate oxycodone and Suboxone formulations

Risk of Misuse

• Combining these medications may indicate:
  • Misunderstanding of proper medication use
  • Potential substance use disorder requiring evaluation
  • Need for comprehensive pain and addiction management

Clinical Bottom Line

The combination of oxycodone and Suboxone is contraindicated due to pharmacological incompatibility, risk of precipitated withdrawal, and potential for respiratory depression. Patients requiring pain management while on Suboxone should be managed with non-opioid approaches when possible or with careful specialist consultation for severe pain scenarios.