Drug interactions
Butorphanol + Tapentadol
Severity: Major
Butorphanol and Tapentadol: 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's mu antagonist activity can blunt tapentadol analgesia and may precipitate withdrawal in patients physically dependent on mu agonists. When no withdrawal occurs, the two drugs add to sedation and respiratory depression.
What this interaction means in plain words
Butorphanol and Tapentadol 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; Tapentadol belongs to Musculoskeletal.
Why it happens
Competitive mu-receptor antagonism or partial agonism by butorphanol opposes the full agonist effect of tapentadol, while overlapping opioid effects are additive.
What to do
Avoid combining in opioid-dependent or chronically treated patients. If used, monitor for withdrawal, loss of analgesia 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 Butorphanol
- Butorphanol + Olanzapine / samidorphan Contraindicated
- Butorphanol + Sodium oxybate Contraindicated
- Alfentanil + Butorphanol Major
- Alprazolam + Butorphanol Major
- Alvimopan + Butorphanol Major
- Amobarbital + Butorphanol Major
Other interactions of Tapentadol
- Calcium / magnesium / potassium / sodium oxybates + Tapentadol Contraindicated
- Isocarboxazid + Tapentadol Contraindicated
- Linezolid + Tapentadol Contraindicated
- Methylene blue + Tapentadol Contraindicated
- Olanzapine / samidorphan + Tapentadol Contraindicated
- Phenelzine + Tapentadol Contraindicated
Frequently asked questions
Can I take Butorphanol with Tapentadol?
MediHelp rates the interaction as major. Butorphanol and Tapentadol 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's mu antagonist activity can blunt tapentadol analgesia and may precipitate withdrawal in patients physically dependent on mu agonists. When no withdrawal occurs, the two drugs add to sedation and respiratory depression.
How serious is the interaction between Butorphanol and Tapentadol?
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 combining in opioid-dependent or chronically treated patients. If used, monitor for withdrawal, loss of analgesia and respiratory depression.
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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