Adolph asked
Why are amiodarone and buprenorphine not compatible? Recently had double bypass surgery with mitral valve replacement as well as an ICD implanted. Had been on buprenorphine for over 2 years for management of chronic pain- spinal stenosis, diabetic neuropathy, PAD. Anything compatible for pain management and antirhytmic medications? Thank you.
Answer
There is considered to be a major interaction between amiodarone and buprenorphine.
The prescribing information for buprenorphine states the drug should not be used with Class 1A and Class III anti-arrhythmic medications (which includes amiodarone). Buprenorphine is associated with QT prolongation, a type of arrhythmia and torsade de pointes (TdP).
In addition to the potential arrhythmic effects of buprenorphine, there is an interaction based on how amiodarone inhibits the metabolizing enzyme CYP3A4. Much of the metabolism of buprenorphine is mediated by CYP3A4. Amiodarone is a strong inhibitor of this enzyme. CYP3A4 inhibition will potentially decease the metabolism and elimination of buprenorphine, which could cause prolonged or increased opioid effects. This in turn increases the risk of adverse reactions such as sedation, dizziness and respiratory depression.
Most opioid pain medications are mediated, at least to a point, by CYP3A4. You should discuss with your doctor potential pain management options for your situation.
