Buprenorphine and MAOI's

Does buprenorphine treat depression? Is my depression from Suboxone? Will Suboxone treat bipolar? Will naltrexone or Vivitrol make me depressed?
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TeeJay
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Buprenorphine and MAOI's

Post by TeeJay » Fri Mar 22, 2019 11:45 am

Has anyone been prescribed MAOI's while taking buprenorphine? Were there any issues or interactions worth noting?

My doctor mentioned the possibility of going on Moclebemide. It's a reversible MAOI, so there's less issues than the non-reversible kind (Parnate / Nardil / Emsam etc).

Interested to get your thoughts.

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Re: Buprenorphine and MAOI's

Post by docm2 » Wed Mar 27, 2019 9:58 am

Sorry you didn't get any responses, but MAO use here is very rare. In 30 years I've prescribed maybe 5 times.
I have a program for UpToDate that will do a drug/drug interaction analysis. Risk rating of X - avoid


Title Monoamine Oxidase Inhibitors / Buprenorphine


Risk Rating X: Avoid combination
below is their verbage

Summary Buprenorphine may enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Severity Major Reliability Rating Fair

Patient Management When possible, avoid use of buprenorphine in patients who have used a monoamine oxidase inhibitor within the past 14 days due to possible severe adverse effects.


Monoamine Oxidase Inhibitors Interacting Members Isocarboxazid, Linezolid, Methylene Blue, Moclobemide, Phenelzine, Procarbazine, Rasagiline, Safinamide, Selegiline, Syrian Rue, Tedizolid, Tranylcypromine

Discussion One case report describes a patient on tricyclic antidepressants who developed serotonin syndrome after taking a single dose of unprescribed buprenorphine/naloxone.1 The patient's symptoms improved following treatment with serotonin receptor antagonist cyproheptadine. This report is in contrast to animal and other experimental data that reported no significant serotonergic effects for buprenorphine and predicted a low risk of serotonin syndrome interactions.2,3

Also, of note, the buprenorphine prescribing information does not list monoamine oxidase inhibitors as a possible drug interaction, but the associated medication guide does warn patients not to take buprenorphine within 14 days of a monoamine oxidase inhibitor.4

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TeeJay
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Re: Buprenorphine and MAOI's

Post by TeeJay » Fri Mar 29, 2019 2:33 am

Moclobemide is slightly different to most of the other MAOI's in that it's a reversible molecule. It doesn't create the same tyramine / cheese reaction as nardil / parnate etc. Perhaps this means it won't have the same problems with buprenorphine as it does with pethidine and Tramadol.

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Re: Buprenorphine and MAOI's

Post by docm2 » Fri Mar 29, 2019 7:23 am

Yes it is, but still listed with the other. In our risk adverse society I don't think anyone would risk it.

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