What are the potential interactions between tirzepatide (Mounjaro) and Suboxone (buprenorphine/naloxone)?

Potential Interactions Between Tirzepatide and Suboxone (Buprenorphine/Naloxone)

Tirzepatide may delay the absorption of buprenorphine/naloxone due to its effect on gastric emptying, but no severe or contraindicated interactions are documented between these medications. 1

Mechanism of Potential Interaction

• Tirzepatide delays gastric emptying, which can impact the absorption of orally administered medications, potentially affecting the bioavailability of sublingual buprenorphine/naloxone 1, 2
• Buprenorphine is a partial mu-opioid receptor agonist that is transported in part by P-glycoprotein (P-gp), but tirzepatide is not known to significantly affect P-gp transport mechanisms 3, 4

Clinical Significance

• No direct contraindications or severe interactions between tirzepatide and buprenorphine/naloxone have been documented in clinical guidelines 3
• The interaction is likely of low clinical significance as:
  • Buprenorphine is administered sublingually, which may partially bypass the gastric emptying effects of tirzepatide 4, 5
  • Neither medication is a potent inhibitor or inducer of the metabolic pathways used by the other 3, 2

Monitoring Recommendations

• Monitor for potential changes in buprenorphine effectiveness if initiating or adjusting tirzepatide dosage 3, 2
• Be vigilant for gastrointestinal side effects, which are common with tirzepatide and could potentially affect the absorption of buprenorphine 6, 2
• Pay particular attention to electrolyte disturbances if severe gastrointestinal symptoms (vomiting, diarrhea) occur with tirzepatide, as these can lead to serious cardiac complications 6

Specific Considerations

• If a patient experiences reduced effectiveness of buprenorphine/naloxone after starting tirzepatide, consider:
  • Separating administration times to maximize absorption of each medication 1
  • Monitoring for withdrawal symptoms that might indicate decreased buprenorphine bioavailability 5, 7
• Tirzepatide's effects on gastric emptying tend to be most pronounced at higher doses (15mg weekly), so dose-dependent interactions may be possible 6, 2

Precautions

• Unlike some drug combinations involving buprenorphine (such as with amiodarone and sofosbuvir), there are no documented life-threatening interactions with tirzepatide 3
• The combination does not appear on contraindicated drug lists in hepatitis C treatment guidelines where buprenorphine interactions are extensively documented 3

Common Pitfalls to Avoid

• Don't confuse this potential mild interaction with the more serious interactions that occur between buprenorphine and potent P-gp inducers or inhibitors 3
• Avoid assuming that all GLP-1 receptor agonists have identical drug interaction profiles; tirzepatide has a unique dual GIP/GLP-1 mechanism that may have different effects than other medications in this class 2
• Don't overlook the possibility of additive side effects such as nausea, which is common with both medications 4, 2