Dosing & Uses
Dosage Forms & Strengths
injectable solution: Schedule IV
- 1mg/mL
- 2mg/mL
nasal spray: Schedule IV
- 10 mg/mL (1mg/spray)
Pain
Indicated for pain when use of opioid analgesic is appropriate
IV: 1 mg IV q3-4hr PRN; dosage range 0.5-2 mg q3-4hr
IM: 2 mg IM q3-4 hr; dosage range 1-4 mg q3-4hr
Intranasal
- Initial: 1 mg (1 spray in 1 nostril); may repeat once after 60-90 min if inadequate pain relief
- Depending on pain severity, by give initial dose of 2 mg (1 spray in each nostril); patient must remain recumbant; do not repeat this dose
- Maintenance: 1 mg (1 spray in 1 nostril) q3-4hr prn
Balanced Anesthesia
2 mg IV before induction and/or 0.5-1 mg increments during anesthesia (higher dose may be required, up to 0.06 mg/kg, or 4 mg/70 kg)
Total cumulative dose varies; typically ranges between 4-12.5 mg (0.06-0.18 mg/kg)
Labor Pain
Indicated for labor pain in full-term (37 weeks gestation or more) women without fetal distress in early labor
1-2 mg/dose IV/IM; may repeat PRN q4hr
Decrease dose if concomitantly used with other analgesics or CNS depressants
Do not administer within 4 hr of anticipated delivery
Preoperative & Preanesthesia
2 mg IM 60-90 minutes preop
This dose is approximately equipotent to morphine 10 mg or meperidine 80 mg
Renal & Hepatic Impairment
Decrease initial dose by 50% (0.5 mg IV and 1 mg IM)
Increase dose interval from q4hr to q6hr
Intranasal
- 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control
- Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn
<18 years old: Not recommended
Pain
Decrease initial dose by 50% (0.5 mg IV and 1 mg IM)
Increase dose interval from q4hr to q6hr
Intranasal
- 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control
- Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- alvimopan
alvimopan, butorphanol. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.
Serious - Use Alternative (50)
- alfentanil
butorphanol, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- belladonna and opium
butorphanol, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
butorphanol decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients. - buprenorphine
buprenorphine, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- buprenorphine buccal
buprenorphine buccal, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- calcium/magnesium/potassium/sodium oxybates
butorphanol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- cimetidine
cimetidine increases effects of butorphanol by decreasing metabolism. Avoid or Use Alternate Drug.
- clonidine
clonidine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.
- codeine
butorphanol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- dextromoramide
butorphanol, dextromoramide. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diamorphine
butorphanol, diamorphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diazepam intranasal
diazepam intranasal, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- difenoxin hcl
butorphanol, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diphenoxylate hcl
butorphanol, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- dipipanone
butorphanol, dipipanone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- eluxadoline
butorphanol, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .
- fentanyl
fentanyl, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl intranasal
fentanyl intranasal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl transdermal
fentanyl transdermal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl transmucosal
fentanyl transmucosal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - hydrocodone
butorphanol decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.
hydrocodone, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - hydromorphone
butorphanol, hydromorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- isocarboxazid
isocarboxazid increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- levorphanol
butorphanol, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- linezolid
linezolid increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- meperidine
butorphanol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- methadone
butorphanol, methadone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- methylene blue
methylene blue and butorphanol both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities
- metoclopramide intranasal
butorphanol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- morphine
butorphanol, morphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- nalbuphine
butorphanol, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oliceridine
butorphanol, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.
- opium tincture
butorphanol, opium tincture. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxycodone
butorphanol, oxycodone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxymorphone
butorphanol, oxymorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- ozanimod
ozanimod and butorphanol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- papaveretum
butorphanol, papaveretum. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- pentazocine
butorphanol, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- phenelzine
phenelzine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- procarbazine
procarbazine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of additive CNS, respiratory and hypotensive effects. .
- rasagiline
rasagiline increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. May cause additive CNS depression, drowsiness, dizziness or hypotension, so use with MAOIs should be cautious; lower initial dosages of the analgesic are recommended followed by careful titration. Avoid combination within 14 days of MAOI use.
- selegiline transdermal
selegiline transdermal increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
selinexor, butorphanol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sodium oxybate
butorphanol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sufentanil
butorphanol, sufentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- sufentanil SL
butorphanol decreases effects of sufentanil SL by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of opioid mixed agonist/antagonist or partial agonist may reduce sufentail SL analgesic effect and/or precipitate withdrawal symptoms.
sufentanil SL, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - tapentadol
butorphanol, tapentadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- tramadol
tramadol, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.
butorphanol, tramadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx. - tranylcypromine
tranylcypromine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- valerian
valerian and butorphanol both increase sedation. Avoid or Use Alternate Drug.
Monitor Closely (189)
- albuterol
butorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and butorphanol both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and butorphanol both increase sedation. Use Caution/Monitor.
- amitriptyline
butorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- amoxapine
butorphanol and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
butorphanol and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
butorphanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
butorphanol and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
butorphanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- azelastine
azelastine and butorphanol both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and butorphanol both increase sedation. Use Caution/Monitor.
- belladonna and opium
butorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.
- benperidol
butorphanol and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
butorphanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexanolone
brexanolone, butorphanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and butorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and butorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and butorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
butorphanol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and butorphanol both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
butorphanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and butorphanol both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and butorphanol both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and butorphanol both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and butorphanol both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.
- chlorpromazine
butorphanol and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and butorphanol both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and butorphanol both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and butorphanol both increase sedation. Use Caution/Monitor.
- clobazam
butorphanol, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
butorphanol and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and butorphanol both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and butorphanol both increase sedation. Use Caution/Monitor.
- clozapine
butorphanol and clozapine both increase sedation. Use Caution/Monitor.
- codeine
butorphanol and codeine both increase sedation. Use Caution/Monitor.
- cyclizine
cyclizine and butorphanol both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and butorphanol both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and butorphanol both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and butorphanol both increase sedation. Use Caution/Monitor.
- daridorexant
butorphanol and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desflurane
desflurane and butorphanol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
butorphanol and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
butorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.
- dexfenfluramine
butorphanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and butorphanol both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
butorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
butorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
butorphanol and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
butorphanol and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and butorphanol both increase sedation. Use Caution/Monitor.
- diethylpropion
butorphanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and butorphanol both increase sedation. Use Caution/Monitor.
- difenoxin hcl
butorphanol and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and butorphanol both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and butorphanol both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
butorphanol and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
butorphanol and dipipanone both increase sedation. Use Caution/Monitor.
- dobutamine
butorphanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
butorphanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
butorphanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
butorphanol and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
butorphanol and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and butorphanol both increase sedation. Use Caution/Monitor.
- droperidol
butorphanol and droperidol both increase sedation. Use Caution/Monitor.
- ephedrine
butorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
butorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
butorphanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, butorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and butorphanol both increase sedation. Use Caution/Monitor.
- ethanol
butorphanol and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and butorphanol both increase sedation. Use Caution/Monitor.
- fenfluramine
butorphanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
butorphanol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
butorphanol and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and butorphanol both increase sedation. Use Caution/Monitor.
- formoterol
butorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gabapentin
gabapentin, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- haloperidol
butorphanol and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
butorphanol and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and butorphanol both increase sedation. Use Caution/Monitor.
- iloperidone
butorphanol and iloperidone both increase sedation. Use Caution/Monitor.
- imipramine
butorphanol and imipramine both increase sedation. Use Caution/Monitor.
- isoproterenol
butorphanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and butorphanol both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
butorphanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, butorphanol. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
butorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
butorphanol and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
butorphanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
butorphanol and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
butorphanol and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and butorphanol both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and butorphanol both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and butorphanol both increase sedation. Use Caution/Monitor.
- loxapine
butorphanol and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
butorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, butorphanol. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
butorphanol and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
butorphanol and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
butorphanol and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
butorphanol and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
butorphanol and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
butorphanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and butorphanol both increase sedation. Use Caution/Monitor.
- methadone
butorphanol and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
butorphanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and butorphanol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
butorphanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and butorphanol both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with opioids increases risk of respiratory depression. Use only when alternative treatment options are inadequate. Use minimum required dosing.
- midodrine
butorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
butorphanol and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
butorphanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
butorphanol and morphine both increase sedation. Use Caution/Monitor.
- motherwort
butorphanol and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
butorphanol and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
butorphanol and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
butorphanol and nalbuphine both increase sedation. Use Caution/Monitor.
- norepinephrine
butorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
butorphanol and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
butorphanol and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- opium tincture
butorphanol and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and butorphanol both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and butorphanol both increase sedation. Use Caution/Monitor.
- oxycodone
butorphanol and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
butorphanol and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
butorphanol and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
butorphanol and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
butorphanol and papaverine both increase sedation. Use Caution/Monitor.
- pegvisomant
butorphanol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
butorphanol and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- perampanel
perampanel and butorphanol both increase sedation. Use Caution/Monitor.
- perphenazine
butorphanol and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
butorphanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- phentermine
butorphanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
butorphanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
butorphanol increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
butorphanol and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
butorphanol and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
butorphanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and butorphanol both increase sedation. Use Caution/Monitor.
- prochlorperazine
butorphanol and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and butorphanol both increase sedation. Use Caution/Monitor.
- propofol
propofol and butorphanol both increase sedation. Use Caution/Monitor.
- propylhexedrine
butorphanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
butorphanol and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and butorphanol both increase sedation. Use Caution/Monitor.
- quetiapine
butorphanol and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
butorphanol and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, butorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- risperidone
butorphanol and risperidone both increase sedation. Use Caution/Monitor.
- salmeterol
butorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
butorphanol and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- selegiline
selegiline increases toxicity of butorphanol by unknown mechanism. Use Caution/Monitor. Concomitant use of butorphanol with other CNS depressants can potentiate the effects of butorphanol on respiratory depression, CNS depression and sedation.hyperpyrexia, somnolence, or death.
- sevoflurane
sevoflurane and butorphanol both increase sedation. Use Caution/Monitor.
- shepherd's purse
butorphanol and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concurrent use of medications with CNS depressant effects together with thalidomide should be avoided due to the risk for additive sedative effects.
- sufentanil
butorphanol and sufentanil both increase sedation. Use Caution/Monitor.
- suvorexant
suvorexant and butorphanol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
butorphanol and tapentadol both increase sedation. Use Caution/Monitor.
- temazepam
temazepam and butorphanol both increase sedation. Use Caution/Monitor.
- terbutaline
butorphanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
butorphanol and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
butorphanol and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
butorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
butorphanol and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
butorphanol and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and butorphanol both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and butorphanol both increase sedation. Use Caution/Monitor.
- trifluoperazine
butorphanol and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
butorphanol and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and butorphanol both increase sedation. Use Caution/Monitor.
- xylometazoline
butorphanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
butorphanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
butorphanol and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
butorphanol and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
butorphanol and zotepine both increase sedation. Use Caution/Monitor.
Minor (6)
- brimonidine
brimonidine increases effects of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- dextroamphetamine
dextroamphetamine increases effects of butorphanol by unspecified interaction mechanism. Minor/Significance Unknown.
- eucalyptus
butorphanol and eucalyptus both increase sedation. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- sage
butorphanol and sage both increase sedation. Minor/Significance Unknown.
- ziconotide
ziconotide, butorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
Adverse Effects
>10%
Sedation (43%)
Dizziness (19%)
Nasal congestion (13%)
Nausea and/or vomiting (13%)
Insomnia (11%)
1-10%
Anorexia
Anxiety
Blurred vision
Bronchitis
Confusion
Constipation
Cough
Dizziness
Dry mouth
Dyspnea
Ear pain
Epistaxis
Euphoria
Floating feeling
Headache
Lethargy
Nasal irritation
Nervousness
Paresthesia
Palpitations
Pharyngitis
Pruritis
Rhinitis
Sensation of heat
Sinus congestion
Sinusitis
Stomach pain
Sweating/clammy
Taste abnormalities
Tinnitus
Tremor
URI
Vasodilation
<1%
Apnea
Increased/decreased BP
Bradycardia
Chest pain
Respiratory depression
Tachycardia
Warnings
Contraindications
Absolute: opioid dependence, respiratory depression, respiratory failure
Relative: cardiac arrhythmias, cardiovascular disease, coronary insufficiency, myocardial infarction, toxin-mediated diarrhea
Cautions
Drug abuse, emotional lability, head injury, hepatic/renal impairment, incr ICP, GI/urinary obstruction, BPH, hypothyroidism
Less risk of respiratory sedation than with pure opioid agonist
May produce withdrawal in opioid dependent pts
Avoid alcohol
Pregnancy & Lactation
Pregnancy Category: C; D if used for prolonged periods or near term
Lactation: excreted in breast milk, but infant likely exposed to insignificant amounts (AAP Committee states compatible w/ nursing)
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Narcotic agonist-analgesic of kappa opiate receptors and partial agonist of mu opiate receptors; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation
Pharmacokinetics
Half-life: 4.6 hr
Onset: <10 min (IV); 5-10 min (IM); within 15 min (nasal)
Duration: 3-4 hr (IV/IM); 4-5hr (nasal);
Peak effect: 0.5-1hr (IM); 4-5min (IV)
Bioavailability: 60-70% (nasal)
Protein Bound: 80%
Vd: 487 L (range: 305-901 L)
Metabolites: hydroxybutorphanol; N-dealkylation & conjugation of butorphanol & its metabolites)
Metabolism: Liver (hydroxylation)
Excretion: Urine (primarily)
Administration
IV Compatibilities
Syringe: (partial list) atropine, diphenhydramine, fentanyl, hydroxyzine, meperidine, metoclopramide, midazolam, prochlorperazine, promethazine
Y-site: (partial list) allopurinol, bivalirudin, labetalol, linezolid, propofol
IV Incompatibilities
Syringe: dimenhydrinate, pentobarbital
Y-site: amphotericin B cholesteryl SO4, midazolam
IV Administration
pH: 3.0-5.5
IM/IV injection
Storage
Store at room temp
Protect from freezing
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 1 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 1 mg/mL vial |  | |
| butorphanol nasal - | 10 mg/mL aerosol |  | |
| butorphanol nasal - | 10 mg/mL aerosol |  | |
| butorphanol nasal - | 10 mg/mL aerosol |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
butorphanol injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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