Drug interactions
Benzhydrocodone / acetaminophen + Butorphanol
Severity: Major
Benzhydrocodone / acetaminophen and Butorphanol: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Benzhydrocodone is a prodrug of hydrocodone, a full mu agonist, so combining it with butorphanol can cause additive sedation and respiratory depression. Butorphanol may also reduce hydrocodone analgesia or precipitate withdrawal in opioid-dependent patients.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Butorphanol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive opioid CNS and respiratory depression, plus partial mu antagonism by butorphanol competing with hydrocodone.
What to do
Avoid the combination and use one opioid. If both are unavoidable, use the lowest doses for the shortest duration and monitor respiration, sedation and withdrawal.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Butorphanol
- Butorphanol + Olanzapine / samidorphan Contraindicated
- Butorphanol + Sodium oxybate Contraindicated
- Alfentanil + Butorphanol Major
- Alprazolam + Butorphanol Major
- Alvimopan + Butorphanol Major
- Amobarbital + Butorphanol Major
Frequently asked questions
Can I take Benzhydrocodone / acetaminophen with Butorphanol?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Butorphanol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Benzhydrocodone is a prodrug of hydrocodone, a full mu agonist, so combining it with butorphanol can cause additive sedation and respiratory depression. Butorphanol may also reduce hydrocodone analgesia or precipitate withdrawal in opioid-dependent patients.
How serious is the interaction between Benzhydrocodone / acetaminophen and Butorphanol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and use one opioid. If both are unavoidable, use the lowest doses for the shortest duration and monitor respiration, sedation and withdrawal.
What other medicines interact with Butorphanol?
MediHelp also lists interactions of Butorphanol with, for example, Olanzapine / samidorphan, Sodium oxybate, Alfentanil. The full list is on the Butorphanol page.
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