Ethanol Increases Suboxone (Buprenorphine/Naloxone) Absorption and Respiratory Depression Risk
Ethanol significantly increases buprenorphine absorption and enhances its respiratory depressant effects, creating a dangerous drug interaction that can lead to severe respiratory depression, sedation, and potentially fatal outcomes. 1
Pharmacokinetic Interaction
- Ethanol alters buprenorphine metabolism, decreasing the area under the concentration-time curve while increasing the volume of distribution of buprenorphine 1
- Alcohol consumption leads to increased production of norbuprenorphine (NBUP), the main metabolite of buprenorphine with respiratory depressant properties 1
- This interaction is primarily pharmacokinetic, resulting in altered drug metabolism and distribution 1
Clinical Effects and Risks
- The ethanol/buprenorphine combination results in marked sedation and respiratory depression 1
- Studies show ethanol causes a further decrease in oxycodone-induced respiratory depression by 19%, and similar mechanisms apply to buprenorphine 2
- Ethanol combined with opioids significantly increases the number of apneic events 2
- The respiratory depression from this combination is not easily reversed with naloxone, making it particularly dangerous 1
Risk Factors and Special Populations
- Elderly patients are more vulnerable to the combined respiratory depressant effects of ethanol and opioids 2
- Patients with pre-existing respiratory conditions are at heightened risk 3
- Individuals with a history of substance use disorder may be particularly vulnerable to this interaction 3
Mechanism of Interaction
- Ethanol inhibits the development of tolerance to opioid-induced respiratory depression 4
- The combination affects central respiratory control centers more profoundly than either substance alone 1
- Ethanol may enhance buprenorphine's binding to mu-opioid receptors, intensifying its effects 1
Clinical Recommendations
- Concomitant use of buprenorphine and ethanol should be strictly avoided due to the risk of respiratory depression 3
- Patients on Suboxone should be clearly warned about the dangers of alcohol consumption 3
- For patients with alcohol use disorder who are on buprenorphine maintenance therapy, more frequent monitoring may be necessary 3
- Healthcare providers should consider the potential for this interaction when prescribing buprenorphine to patients with a history of alcohol use 3
Monitoring and Management
- Patients who have consumed both substances require close monitoring for signs of respiratory depression 1
- Standard doses of naloxone may not effectively reverse the respiratory depression caused by this combination 1
- Higher doses or continuous infusion of naloxone may be required in overdose situations 1
- Consider hospitalization for monitoring in cases of significant combined ingestion 3
Additional Considerations
- The combination of ethanol and buprenorphine may also increase the risk of serotonin syndrome in patients taking serotonergic medications 5
- Ethanol can exacerbate the QT-prolonging effects of buprenorphine, increasing the risk of cardiac arrhythmias 6
- The combination may also increase the risk of sedation-related accidents and injuries 3