Atazanavir and Buprenorphine and naloxone interaction
Atazanavir and Buprenorphine and naloxone: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.
Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.
What the FDA labels say
From the Atazanavir (REYATAZ) label · effective 2024-12-05
REYATAZ ↓ atazanavir The coadministration of REYATAZ and buprenorphine without ritonavir is not recommended.
Opioids: buprenorphine REYATAZ or REYATAZ with ritonavir ↑ buprenorphine ↑ norbuprenorphine Coadministration of REYATAZ with ritonavir and buprenorphine warrants clinical monitoring for sedation and cognitive effects.
A dose reduction of buprenorphine may be considered.
From the Buprenorphine and naloxone label · effective 2026-06-16
Other PIs with CYP3A4 inhibitory activity (atazanavir and atazanavir/ritonavir) resulted in elevated levels of buprenorphine and norbuprenorphine, and patients in one study reported increased sedation.
Intervention: Monitor patients taking buprenorphine and naloxone sublingual tablets and atazanavir with and without ritonavir, and reduce dose of buprenorphine and naloxone sublingual tablets if warranted.
Monitor patients taking buprenorphine and atazanavir with and without ritonavir, and reduce dose of buprenorphine if warranted.
Inhibitors of CYP3A4 Clinical Impact: The concomitant use of buprenorphine and CYP3A4 inhibitors can increase the plasma concentration of buprenorphine, resulting in increased or prolonged opioid effects, particularly when an inhibitor is added after a stable dose of buprenorphine and naloxone sublingual tablet is achieved.
After stopping a CYP3A4 inhibitor, as the effects of the inhibitor decline, the buprenorphine plasma concentration will decrease [see Clinical Pharmacology (12.3) ] , potentially resulting in decreased opioid efficacy or a withdrawal syndrome in patients who had developed physical dependence to buprenorphine.
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Open in the checkerNot medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.