Drug interactions
Butabarbital + Meperidine
Severity: Major
Butabarbital and Meperidine: 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
Barbiturates and opioids together produce additive sedation and respiratory depression. Barbiturates also induce hepatic enzymes, which may increase formation of meperidine's neurotoxic metabolite normeperidine. The risk of profound CNS depression is increased, especially in older or frail patients.
What this interaction means in plain words
Butabarbital and Meperidine 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 CNS depression; barbiturate induction of CYP enzymes can increase conversion of meperidine to normeperidine.
What to do
Avoid the combination when feasible, otherwise start with reduced doses of both agents. Monitor sedation and respiratory rate and watch for tremor or seizures.
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 Meperidine
- Alvimopan + Meperidine Contraindicated
- Isocarboxazid + Meperidine Contraindicated
- Meperidine + Methylene blue Contraindicated
- Meperidine + Olanzapine / samidorphan Contraindicated
- Meperidine + Phenelzine Contraindicated
- Meperidine + Procarbazine Contraindicated
Frequently asked questions
Can I take Butabarbital with Meperidine?
MediHelp rates the interaction as major. Butabarbital and Meperidine 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. Barbiturates and opioids together produce additive sedation and respiratory depression. Barbiturates also induce hepatic enzymes, which may increase formation of meperidine's neurotoxic metabolite normeperidine. The risk of profound CNS depression is increased, especially in older or frail patients.
How serious is the interaction between Butabarbital and Meperidine?
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 when feasible, otherwise start with reduced doses of both agents. Monitor sedation and respiratory rate and watch for tremor or seizures.
What other medicines interact with Meperidine?
MediHelp also lists interactions of Meperidine with, for example, Alvimopan, Isocarboxazid, Methylene blue. The full list is on the Meperidine page.
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