Drug interactions
Butorphanol + Diamorphine
Severity: Major
Butorphanol and Diamorphine: 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
Diamorphine (heroin) is a full mu agonist, and butorphanol can add to sedation and respiratory depression. In opioid-dependent patients butorphanol may precipitate withdrawal or reduce analgesia.
What this interaction means in plain words
Butorphanol and Diamorphine 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 partial mu antagonism by butorphanol competing with diamorphine.
What to do
Avoid the combination; do not give butorphanol to patients dependent on or recently treated with diamorphine. If unavoidable, monitor respiration, sedation and withdrawal.
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 Butorphanol with Diamorphine?
MediHelp rates the interaction as major. Butorphanol and Diamorphine 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. Diamorphine (heroin) is a full mu agonist, and butorphanol can add to sedation and respiratory depression. In opioid-dependent patients butorphanol may precipitate withdrawal or reduce analgesia.
How serious is the interaction between Butorphanol and Diamorphine?
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; do not give butorphanol to patients dependent on or recently treated with diamorphine. If unavoidable, monitor respiration, sedation and withdrawal.
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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