Drug interactions
Butorphanol + Methylene blue
Severity: Major
Butorphanol and Methylene blue: 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
Methylene blue inhibits monoamine oxidase A and can cause serotonin syndrome with serotonergic drugs. Butorphanol has weak serotonergic concern, so the risk is lower than with some other opioids but still reported in labeling.
What this interaction means in plain words
Butorphanol and Methylene blue 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
Methylene blue's reversible MAO-A inhibition raises serotonin, with possible additive serotonergic effect from the opioid.
What to do
Avoid the combination where an alternative analgesic is available. If it must be given, monitor for agitation, clonus, hyperthermia and autonomic instability and stop at the first signs.
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 Methylene blue?
MediHelp rates the interaction as major. Butorphanol and Methylene blue 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. Methylene blue inhibits monoamine oxidase A and can cause serotonin syndrome with serotonergic drugs. Butorphanol has weak serotonergic concern, so the risk is lower than with some other opioids but still reported in labeling.
How serious is the interaction between Butorphanol and Methylene blue?
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 where an alternative analgesic is available. If it must be given, monitor for agitation, clonus, hyperthermia and autonomic instability and stop at the first signs.
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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