Drug interactions
Butorphanol + Tramadol
Severity: Major
Butorphanol and Tramadol: 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 can antagonize the mu-opioid effect of tramadol and may precipitate withdrawal in opioid-dependent patients, while the combination also increases sedation and respiratory depression. Tramadol additionally lowers seizure threshold and has serotonergic activity, which adds to the risk.
What this interaction means in plain words
Butorphanol and Tramadol 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; Tramadol belongs to Musculoskeletal.
Why it happens
Butorphanol's mu antagonist and partial agonist activity opposes tramadol's opioid effect, while the two have additive CNS depressant effects.
What to do
Avoid concurrent use in patients on chronic opioid therapy; select a single opioid regimen. If both are given, monitor for withdrawal, inadequate analgesia, sedation 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 Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Frequently asked questions
Can I take Butorphanol with Tramadol?
MediHelp rates the interaction as major. Butorphanol and Tramadol 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 can antagonize the mu-opioid effect of tramadol and may precipitate withdrawal in opioid-dependent patients, while the combination also increases sedation and respiratory depression. Tramadol additionally lowers seizure threshold and has serotonergic activity, which adds to the risk.
How serious is the interaction between Butorphanol and Tramadol?
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 concurrent use in patients on chronic opioid therapy; select a single opioid regimen. If both are given, monitor for withdrawal, inadequate analgesia, sedation 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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