Drug interactions
Buprenorphine + Butorphanol
Severity: Major
Buprenorphine and Butorphanol: major interaction.
Last updated Sources: US FDA label
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
Butorphanol is a mixed agonist-antagonist that competes at opioid receptors with buprenorphine, a partial agonist. This may reduce analgesia or precipitate withdrawal in opioid-dependent patients, while still adding sedation.
What this interaction means in plain words
Buprenorphine 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.
Buprenorphine belongs to Musculoskeletal; Butorphanol belongs to Musculoskeletal.
Why it happens
Competing partial agonist and agonist-antagonist activity at mu and kappa opioid receptors.
What to do
Avoid using the two together; choose one opioid for analgesia. If a switch is needed, monitor for withdrawal and inadequate pain control.
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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References
Other interactions of Buprenorphine
- Alvimopan + Buprenorphine Contraindicated
- Buprenorphine + Calcium / magnesium / potassium / sodium oxybates Contraindicated
- Buprenorphine + Olanzapine / samidorphan Contraindicated
- Buprenorphine + Phenelzine Contraindicated
- Buprenorphine + Pimozide Contraindicated
- Buprenorphine + Thioridazine Contraindicated
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 Buprenorphine with Butorphanol?
MediHelp rates the interaction as major. Buprenorphine 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. Butorphanol is a mixed agonist-antagonist that competes at opioid receptors with buprenorphine, a partial agonist. This may reduce analgesia or precipitate withdrawal in opioid-dependent patients, while still adding sedation.
How serious is the interaction between Buprenorphine 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 using the two together; choose one opioid for analgesia. If a switch is needed, monitor for withdrawal and inadequate pain control.
What other medicines interact with Buprenorphine?
MediHelp also lists interactions of Buprenorphine with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Olanzapine / samidorphan. The full list is on the Buprenorphine page.
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