Cordarone and Sublocade

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Amiodarone can increase the blood levels and effects of buprenorphine. Contact your doctor if you experience dizziness, fainting, confusion, excessive drowsiness, slow heart rate, shallow or difficult breathing, and/or shortness of breath. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor. The following also applies if you are receiving buprenorphine in the form of a skin patch for pain: Talk to your doctor before using the skin patch together with amiodarone. Combining these medications can increase the risk of an irregular heart rhythm that may be serious, especially if you are on a higher dosage of the patch. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, or fast or pounding heartbeats during treatment with these medications, whether together or alone. Do not use more of these medications than what your doctor prescribed.

GENERALLY AVOID: Buprenorphine administered transdermally at a higher than recommended dosage has been associated with prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval such as amiodarone may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. In healthy volunteers, there was no difference in the effect of buprenorphine 10 mcg/hr administered transdermally on the QT interval compared to placebo. However, buprenorphine 40 mcg/hr (twice the maximum recommended dosage) was associated with a mean prolongation of the QT interval of 5.9 msec compared to placebo. Buprenorphine 20 mcg/hr was not studied. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: According to the product labeling, use of buprenorphine transdermal films should be avoided in patients treated with class IA (e.g., disopyramide, quinidine, procainamide) or class III (e.g., amiodarone, dofetilide, sotalol) antiarrhythmic agents. A dosage of 20 mcg/hr should not be exceeded in patients receiving the buprenorphine transdermal system. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, or syncope.

MONITOR: Coadministration with amiodarone may increase the plasma concentrations and pharmacologic effects of buprenorphine. The proposed mechanism is amiodarone inhibition of buprenorphine metabolism via CYP450 3A4. The risk of central nervous system and respiratory depression may be increased.

MANAGEMENT: Pharmacologic response to buprenorphine and vital signs should be monitored more closely whenever a CYP450 3A4 inhibitor such as amiodarone is added to or withdrawn from therapy, and the buprenorphine dosage adjusted as necessary. If clinically significant respiratory depression occurs, buprenorphine should be withdrawn.

Cordarone

Generic Name: amiodarone

Brand name: Cordarone, Pacerone, Nexterone

Synonyms: n.a.

What is Cordarone?

Sublocade

Generic Name: buprenorphine

Brand name: Sublocade, Belbuca, Buprenex, Probuphine, Butrans, Subutex

Synonyms: Sublocade Injection

What is Sublocade?