From the Guidelines
Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) can be safely taken with buprenorphine, as they work through different mechanisms and do not interact dangerously with buprenorphine 1. When considering pain management for patients on buprenorphine, it's essential to prioritize medications that do not interact with buprenorphine, given its unique pharmacological properties as a partial opioid agonist.
- Acetaminophen can be taken at a maximum daily dose of 3,000-4,000mg, divided into doses of 650-1000mg every 6 hours.
- Ibuprofen can be taken at 400-600mg every 6-8 hours, with a maximum daily dose of 3,200mg.
- Naproxen can be taken at 220-500mg every 8-12 hours, not exceeding 1,500mg daily. It's crucial to avoid other opioid pain medications while taking buprenorphine, as buprenorphine can block their effects and potentially lead to withdrawal symptoms, as noted in studies on managing acute pain in patients on buprenorphine therapy 1. Additionally, medications that depress the central nervous system, such as benzodiazepines or alcohol, should be avoided due to the risk of dangerous respiratory depression 1. Always inform your healthcare provider about all medications you're taking, as individual health conditions may affect which pain relievers are appropriate for you, and recent guidelines emphasize the importance of personalized care in managing patients on buprenorphine for opioid use disorder or chronic pain 1.
From the FDA Drug Label
After stopping a CYP3A4 inhibitor, as the effects of the inhibitor decline, the buprenorphine plasma concentration will decrease [see CLINICAL PHARMACOLOGY: Pharmacokinetics], potentially resulting in decreased opioid efficacy or a withdrawal syndrome in patients who had developed physical dependence to buprenorphine Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics Clinical Impact: May reduce the analgesic effect of buprenorphine hydrochloride and/or precipitate withdrawal symptoms. The FDA drug label does not answer the question.
From the Research
Pain Medication Options with Buprenorphine
- Buprenorphine can be used in conjunction with other medications for pain management, but the specific medications that can be taken with it are not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that buprenorphine can be used as an alternative to schedule II opioids for chronic pain, especially in the elderly, and may be associated with less cognitive impairment, falls, sexual dysfunction, and sarcopenia 2.
- For acute pain, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are recommended as first-line treatment options, and may be used in conjunction with buprenorphine, although the specific combination is not mentioned in the studies 3, 6.
- Adjunctive medications, such as muscle relaxants, may be added to the treatment regimen for specific conditions, such as acute low back pain, but it is not specified whether these can be taken with buprenorphine 3.
- Combination therapy using a small amount of opioid, such as buprenorphine, together with a nonopioid pain reliever, has been shown to be effective and reduces opioid consumption 6.
Considerations for Concomitant Medication Use
- When using buprenorphine for opioid use disorder, the training and waiver for licensed practitioners with a DEA has been waived, allowing any provider to prescribe buprenorphine 2.
- The use of buprenorphine for pain management is not as clearly defined as its use for opioid use disorder, but it has been shown to be effective in some studies 4, 5.
- The choice of concomitant medication to use with buprenorphine will depend on the specific patient and condition being treated, and should be made in consultation with a healthcare provider 3, 6.