Drug interactions
Butorphanol + Esketamine
Severity: Major
Butorphanol and Esketamine: 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 an opioid agonist-antagonist that causes sedation and respiratory depression. With esketamine, the risk of marked sedation and respiratory compromise increases.
What this interaction means in plain words
Butorphanol and Esketamine 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; Esketamine belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression via opioid receptor activity and NMDA antagonism.
What to do
Avoid concurrent use if possible; otherwise monitor sedation, respiratory rate and oxygen saturation and use minimal opioid doses.
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 Esketamine
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 Esketamine?
MediHelp rates the interaction as major. Butorphanol and Esketamine 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 an opioid agonist-antagonist that causes sedation and respiratory depression. With esketamine, the risk of marked sedation and respiratory compromise increases.
How serious is the interaction between Butorphanol and Esketamine?
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 if possible; otherwise monitor sedation, respiratory rate and oxygen saturation and use minimal opioid doses.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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