Drug interactions
Butorphanol + Methadone
Severity: Major
Butorphanol and Methadone: 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 precipitate withdrawal in patients physically dependent on methadone. It may also reduce analgesia from methadone and add to sedation.
What this interaction means in plain words
Butorphanol and Methadone 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; Methadone belongs to Musculoskeletal.
Why it happens
Kappa agonist and mu partial agonist/antagonist activity competes with methadone at the mu receptor.
What to do
Avoid use in patients on methadone maintenance or chronic methadone therapy. Choose a full agonist or non-opioid analgesic if additional pain control is needed.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Butorphanol and Methadone, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone 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 Methadone?
MediHelp rates the interaction as major. Butorphanol and Methadone 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 precipitate withdrawal in patients physically dependent on methadone. It may also reduce analgesia from methadone and add to sedation.
How serious is the interaction between Butorphanol and Methadone?
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 use in patients on methadone maintenance or chronic methadone therapy. Choose a full agonist or non-opioid analgesic if additional pain control is needed.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
