Drug interactions
Butorphanol + Codeine
Severity: Major
Butorphanol and Codeine: 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 can reduce the effect of full mu agonists like codeine and may precipitate withdrawal in opioid-dependent patients. It also adds to sedation and respiratory depression.
What this interaction means in plain words
Butorphanol and Codeine 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 belongs to Musculoskeletal; Codeine belongs to Musculoskeletal.
Why it happens
Kappa agonism with partial mu antagonism or agonism competes with codeine's effect, plus additive CNS depression.
What to do
Avoid concurrent use in opioid-dependent patients and generally choose one opioid. If both are given, monitor for withdrawal, pain control and sedation.
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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
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 Butorphanol with Codeine?
MediHelp rates the interaction as major. Butorphanol and Codeine 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 can reduce the effect of full mu agonists like codeine and may precipitate withdrawal in opioid-dependent patients. It also adds to sedation and respiratory depression.
How serious is the interaction between Butorphanol and Codeine?
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 in opioid-dependent patients and generally choose one opioid. If both are given, monitor for withdrawal, pain control and sedation.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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