Butorphanol and Sertraline: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Butorphanol
Sertraline
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Butorphanol is a strong pain medicine, and sertraline (an antidepressant) raises serotonin levels in your body. When taken together, both can nudge serotonin higher. In rare cases this can lead to a reaction called serotonin syndrome, which may cause things like agitation, shivering, fast heartbeat, sweating, muscle twitching, or confusion.
Please know this is considered a theoretical concern, meaning it does not happen often, and many people use combinations like this safely under a doctor's care. The most important time to watch is when you first start or change a dose. Your care team can manage this well, so keep taking both as prescribed and let your pharmacist or doctor know if you feel unwell.
Effect: Additive serotonergic activity from butorphanol (an opioid with weak serotonergic potential) plus sertraline (SSRI) may increase risk of serotonin syndrome.
- Direction: Additive pharmacodynamic effect; neither agent is a prodrug and this is not a CYP-mediated PK interaction.
- Severity: Major, but theoretical evidence only.
- Onset: Unspecified; highest risk at initiation and dose escalation.
- Management: Co-use may proceed when clinically indicated. Monitor for autonomic instability, neuromuscular abnormalities (clonus, hyperreflexia, tremor), and mental status changes, particularly during initiation and titration.
What happens
Increased risk of serotonin syndrome
Interaction Deep Dive
Cases of serotonin syndrome have been documented when butorphanol is taken together with serotonergic agents, such as SSRIs, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, triptans, 5-HT3 receptor antagonists, MAOIs, and additional medications that act on the serotonergic system. When these drugs must be used together, monitor the patient closely, particularly at the start of therapy and when doses are being adjusted12.
Why it happens (mechanism)
Additive serotonergic effects
How to manage this interaction
If your care team decides you need both medicines, that is usually fine, and they can manage this together.
- Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise.
- Expect closer monitoring, especially when you first start either drug or when a dose is changed.
- Watch for symptoms such as agitation, confusion, fast heartbeat, sweating, shivering, muscle twitching, or fever.
- If those symptoms appear, contact your doctor or pharmacist promptly, or seek urgent care if symptoms are severe.
Your team may adjust and individualize your doses as needed to keep you safe.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Butorphanol and Sertraline together?
Taking butorphanol with sertraline can slightly raise the risk of serotonin syndrome, so watch for symptoms like agitation, sweating, or a racing heart, especially when starting or changing doses. Keep taking both as prescribed and tell your care team if you feel unwell. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Butorphanol and Sertraline interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Butorphanol and Sertraline interaction managed?
If your care team decides you need both medicines, that is usually fine, and they can manage this together. Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise. Expect closer monitoring, especially when you first start either drug or when a dose is changed. Watch for symptoms such as agitation, confusion, fast heartbeat, sweating, shivering, muscle twitching, or fev… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Butorphanol or Sertraline need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: Butorphanol tartrate intramuscular injection, intravenous injection, butorphanol tartrate intramuscular injection, intravenous injection. Hospira Inc (per DailyMed), Lake Forest, IL, 2016.
- Product Information: Butorphanol tartrate nasal spray, butorphanol tartrate nasal spray. Mylan Pharmaceuticals Inc (per DailyMed), Morgantown, WV, 2016. DailyMed
Keep reading about Butorphanol
Keep reading about Sertraline
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