Drug interactions
Butorphanol + Hydromorphone
Severity: Major
Butorphanol and Hydromorphone: 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 may reduce hydromorphone analgesia and precipitate withdrawal in opioid-dependent patients. It also adds to sedation.
What this interaction means in plain words
Butorphanol and Hydromorphone 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; Hydromorphone belongs to Musculoskeletal.
Why it happens
Butorphanol acts as a kappa agonist and mu partial agonist or antagonist, competing with hydromorphone.
What to do
Avoid in patients physically dependent on hydromorphone; use a single full agonist where possible. If combined, monitor for withdrawal, pain and respiratory depression.
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 Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
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 Hydromorphone?
MediHelp rates the interaction as major. Butorphanol and Hydromorphone 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 may reduce hydromorphone analgesia and precipitate withdrawal in opioid-dependent patients. It also adds to sedation.
How serious is the interaction between Butorphanol and Hydromorphone?
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 in patients physically dependent on hydromorphone; use a single full agonist where possible. If combined, monitor for withdrawal, pain and respiratory depression.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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