Drug interactions
Butorphanol + Fentanyl intranasal
Severity: Major
Butorphanol and Fentanyl intranasal: 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 can add to the sedation and respiratory depression of fentanyl. Its partial antagonist activity may also lessen fentanyl analgesia or precipitate withdrawal in opioid-tolerant patients.
What this interaction means in plain words
Butorphanol and Fentanyl intranasal 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.
What to do
Avoid the combination, especially in opioid-tolerant patients. If it is unavoidable, reduce doses and 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 Fentanyl intranasal?
MediHelp rates the interaction as major. Butorphanol and Fentanyl intranasal 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 can add to the sedation and respiratory depression of fentanyl. Its partial antagonist activity may also lessen fentanyl analgesia or precipitate withdrawal in opioid-tolerant patients.
How serious is the interaction between Butorphanol and Fentanyl intranasal?
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, especially in opioid-tolerant patients. If it is unavoidable, reduce doses and 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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