Drug interactions
Butabarbital + Methadone
Severity: Major
Butabarbital and Methadone: 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 induce CYP3A4 and other enzymes and can lower methadone concentrations, precipitating withdrawal. They also add to opioid sedation and respiratory depression, so the effects of the combination can be difficult to balance.
What this interaction means in plain words
Butabarbital and Methadone 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
Hepatic enzyme induction increases methadone clearance, while both drugs cause additive CNS depression.
What to do
Monitor for withdrawal after starting the barbiturate and for sedation or toxicity if the barbiturate is stopped. Adjust the methadone dose accordingly.
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 Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Frequently asked questions
Can I take Butabarbital with Methadone?
MediHelp rates the interaction as major. Butabarbital and Methadone 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 induce CYP3A4 and other enzymes and can lower methadone concentrations, precipitating withdrawal. They also add to opioid sedation and respiratory depression, so the effects of the combination can be difficult to balance.
How serious is the interaction between Butabarbital and Methadone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for withdrawal after starting the barbiturate and for sedation or toxicity if the barbiturate is stopped. Adjust the methadone dose accordingly.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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