Drug interactions
Butorphanol + Hydrocodone
Severity: Major
Butorphanol and Hydrocodone: 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 hydrocodone analgesia and precipitate withdrawal in opioid-tolerant patients. It also adds sedation and respiratory depression.
What this interaction means in plain words
Butorphanol and Hydrocodone 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; Hydrocodone belongs to Musculoskeletal.
Why it happens
Partial mu antagonism and kappa agonism by butorphanol competing with hydrocodone, plus additive CNS depression.
What to do
Avoid combining in opioid-tolerant patients and choose a single opioid regimen. If used together, monitor for withdrawal, loss of analgesia 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 Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone 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 Hydrocodone?
MediHelp rates the interaction as major. Butorphanol and Hydrocodone 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 hydrocodone analgesia and precipitate withdrawal in opioid-tolerant patients. It also adds sedation and respiratory depression.
How serious is the interaction between Butorphanol and Hydrocodone?
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 combining in opioid-tolerant patients and choose a single opioid regimen. If used together, monitor for withdrawal, loss of analgesia and sedation.
What other medicines interact with Hydrocodone?
MediHelp also lists interactions of Hydrocodone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydrocodone page.
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