<s>[INST] I recently had blood work done and my liver enzymes were 152, I take pain meds for neck and back pain and xanax as needed.  I started a buprens patch about 4 months ago for pain issues and I'm wondering if this alone could contribute a lot since it keeps a constant level in my blood.  I also take zoloft...any thoughts. [/INST] Hi & Welcome to HCM.Using Butrans (Buprenorphine-opioid analgesic) Patch together with Zoloft  (Sertraline-antidepressant) may increase side effects such as dizziness, drowsiness, confusion, difficulty concentrating or respiratory depression. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination.  Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you.Hope this will help you. </s>