Drug interactions
Buprenorphine buccal + Butorphanol
Severity: Major
Buprenorphine buccal 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
Both drugs are mixed-action opioids acting at mu and kappa receptors, so they can add to sedation and respiratory depression. Competition at the mu receptor may reduce analgesia and precipitate withdrawal in dependent patients.
What this interaction means in plain words
Buprenorphine buccal 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 depression with competition between two partial mu agonists/antagonists, with buprenorphine's high receptor affinity.
What to do
Avoid concurrent use; keep to a single agent. If unavoidable, monitor sedation, respiration and withdrawal symptoms.
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 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 buccal with Butorphanol?
MediHelp rates the interaction as major. Buprenorphine buccal 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. Both drugs are mixed-action opioids acting at mu and kappa receptors, so they can add to sedation and respiratory depression. Competition at the mu receptor may reduce analgesia and precipitate withdrawal in dependent patients.
How serious is the interaction between Buprenorphine buccal 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 concurrent use; keep to a single agent. If unavoidable, monitor sedation, respiration and withdrawal symptoms.
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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