Does Sublocade (buprenorphine) interact with alcohol?

From the Guidelines

It is strongly advised to avoid consuming alcohol while on Sublocade (buprenorphine extended-release injection) due to the risk of severe side effects, including respiratory depression, coma, and even death. Combining Sublocade with alcohol can lead to dangerous interactions, as both substances enhance each other's depressant effects on the central nervous system, significantly increasing the risk of overdose 1. Sublocade is a medication used to treat opioid use disorder, and it works by partially activating opioid receptors in the brain. When alcohol is added to this equation, the risk of adverse reactions increases.

Key Considerations

• The use of Sublocade requires careful management, and patients should be aware of the potential interactions with other substances, including alcohol.
• According to the Mayo Clinic Proceedings, opioid agonist-antagonists like buprenorphine (the active ingredient in Sublocade) can have multiple drug-drug interactions, including those that may result in QT-interval prolongation, serotonin syndrome, or reduced analgesic effect 1.
• The prescribed daily dose of buprenorphine, indication for buprenorphine treatment, risk of relapse, and expected level of postsurgical pain should be reflected in a patient-centered final decision to continue or hold the medication, but this does not change the recommendation to avoid alcohol.
• Since Sublocade is a long-acting medication that remains in your system for at least a month after injection, there is no "safe" time to drink alcohol during treatment.

Clinical Implications

• Patients on Sublocade should be closely monitored for signs of alcohol use or other substance use that could interact with their medication.
• Healthcare providers should offer support and guidance for patients experiencing cravings for alcohol or other substances while on Sublocade.
• The potential for severe side effects and interactions with alcohol underscores the importance of adhering to the prescribed treatment plan and avoiding alcohol consumption altogether while on Sublocade.

From the FDA Drug Label

Clinically significant drug interactions with Buprenorphine Hydrochloride Benzodiazepines and Other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death Intervention: Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Inform patients and caregivers of this potential interaction and educate them on the signs and symptoms of respiratory depression (including sedation) Examples: Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, and other opioids, alcohol

The interaction between Sublocade (buprenorphine) and alcohol can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death due to additive pharmacologic effects. Patients should be educated on the signs and symptoms of respiratory depression, and concomitant prescribing should be reserved for patients with no alternative treatment options, with limited dosages and durations 2.

From the Research

Interaction with Alcohol

• There is no direct evidence in the provided studies that Sublocade (buprenorphine) interacts with alcohol.
• However, it is known that combining buprenorphine with other substances can increase the risk of adverse effects, such as respiratory depression 3, 4.
• Buprenorphine is a partial agonist at the mu opioid receptor and can produce serious respiratory depression, particularly when combined with sedatives such as benzodiazepines 4.
• While there is no specific information on interactions with alcohol, it is generally recommended to avoid combining buprenorphine with other substances that can depress the central nervous system.

Mechanism of Action

• Buprenorphine has a unique pharmacology that offers practical advantages and enhanced safety when prescribed as recommended and supervised by a physician 3.
• It is a partial agonist at the mu opioid receptor, which means it can produce analgesia equivalent to that of full mu-opioid receptor agonists, but with a lower risk of respiratory depression 5.
• The pharmacokinetic properties of buprenorphine are also advantageous in a clinical setting, where metabolic and excretory pathways allow for use in patients requiring concomitant medications, the elderly, and those with renal or hepatic impairment 5.

Safety Profile

• Buprenorphine is considered a safe opioid with a relatively low maximum effect on respiratory depression 4.
• However, it can still produce serious respiratory depression, particularly when combined with sedatives such as benzodiazepines 4.
• The safety profile of buprenorphine is generally favorable compared to that of full mu-opioid receptor agonists for the treatment of chronic pain 5.