Drug interactions
Buprenorphine long-acting + Butorphanol
Severity: Major
Buprenorphine long-acting 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
Long-acting injectable buprenorphine gives prolonged mu receptor occupancy. Adding butorphanol raises the risk of additive sedation and respiratory depression, and may reduce analgesia or precipitate withdrawal.
What this interaction means in plain words
Buprenorphine long-acting 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 competitive partial agonist/antagonist activity at the mu receptor.
What to do
Avoid butorphanol in patients on depot buprenorphine; use non-opioid analgesics where possible. If unavoidable, monitor respiration, sedation and withdrawal over the long duration of buprenorphine exposure.
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 long-acting with Butorphanol?
MediHelp rates the interaction as major. Buprenorphine long-acting 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. Long-acting injectable buprenorphine gives prolonged mu receptor occupancy. Adding butorphanol raises the risk of additive sedation and respiratory depression, and may reduce analgesia or precipitate withdrawal.
How serious is the interaction between Buprenorphine long-acting 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 butorphanol in patients on depot buprenorphine; use non-opioid analgesics where possible. If unavoidable, monitor respiration, sedation and withdrawal over the long duration of buprenorphine exposure.
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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