Drug interactions
Butorphanol + Nalbuphine
Severity: Moderate
Butorphanol and Nalbuphine: moderate interaction.
Last updated
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
Both are mixed agonist-antagonist opioids acting at kappa and mu receptors, so they offer no analgesic advantage together and add sedation and respiratory depression. In opioid-dependent patients, either may precipitate withdrawal.
What this interaction means in plain words
Butorphanol and Nalbuphine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Butorphanol belongs to Musculoskeletal; Nalbuphine belongs to Musculoskeletal.
Why it happens
Overlapping kappa agonist and mu partial agonist or antagonist activity with additive CNS depression.
What to do
Avoid using two agonist-antagonists together; choose one and monitor sedation and respiratory rate.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine 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 Nalbuphine?
MediHelp rates the interaction as moderate. Butorphanol and Nalbuphine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Both are mixed agonist-antagonist opioids acting at kappa and mu receptors, so they offer no analgesic advantage together and add sedation and respiratory depression. In opioid-dependent patients, either may precipitate withdrawal.
How serious is the interaction between Butorphanol and Nalbuphine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid using two agonist-antagonists together; choose one and monitor sedation and respiratory rate.
What other medicines interact with Nalbuphine?
MediHelp also lists interactions of Nalbuphine with, for example, Alvimopan, Olanzapine / samidorphan, Alprazolam. The full list is on the Nalbuphine page.
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