Drug interactions
Butorphanol + Nortriptyline
Severity: Moderate
Butorphanol and Nortriptyline: 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
Nortriptyline has sedative and anticholinergic properties, and combined with an opioid it can increase drowsiness and CNS depression. Additive effects may be more pronounced in older patients.
What this interaction means in plain words
Butorphanol and Nortriptyline 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; Nortriptyline belongs to Central Nervous System.
Why it happens
Additive CNS depression from opioid agonism and tricyclic antihistaminic and anticholinergic effects.
What to do
Monitor sedation, respiratory rate and anticholinergic effects, and use the lowest effective doses. Take extra care in older adults.
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 Butorphanol
- Butorphanol + Olanzapine / samidorphan Contraindicated
- Butorphanol + Sodium oxybate Contraindicated
- Alfentanil + Butorphanol Major
- Alprazolam + Butorphanol Major
- Alvimopan + Butorphanol Major
- Amobarbital + Butorphanol Major
Other interactions of Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Frequently asked questions
Can I take Butorphanol with Nortriptyline?
MediHelp rates the interaction as moderate. Butorphanol and Nortriptyline 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. Nortriptyline has sedative and anticholinergic properties, and combined with an opioid it can increase drowsiness and CNS depression. Additive effects may be more pronounced in older patients.
How serious is the interaction between Butorphanol and Nortriptyline?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sedation, respiratory rate and anticholinergic effects, and use the lowest effective doses. Take extra care in older adults.
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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