Doxepin and Butorphanol Nasal Spray: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Doxepin
Butorphanol Nasal Spray
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.
What happens
Increased risk of serotonin syndrome; increased risk of respiratory and CNS depression
Interaction Deep Dive
Coadministration of butorphanol with CNS depressants may result in sedation and respiratory depression. Coadministration of butorphanol with serotonergic agents including SSRIs, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, triptans, 5-HT3 receptor antagonists, drugs that impair serotonin metabolism, and others that affect the serotonergic system, may result in serotonin syndrome. If concomitant use of butorphanol and a serotonergic agent is necessary, observe the patient especially during treatment initiation and dose adjustment and use the lowest dose and shortest duration necessary to achieve treatment goals21.
Why it happens (mechanism)
Additive serotonergic effects; additive CNS depression
Common questions
Can I take Doxepin and Butorphanol Nasal Spray together?
Increased risk of serotonin syndrome; increased risk of respiratory and CNS depression Always confirm with your pharmacist or prescriber before making any change.
How serious is the Doxepin and Butorphanol Nasal Spray 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 strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Doxepin or Butorphanol Nasal Spray 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 nasal spray, butorphanol tartrate nasal spray. Mylan Pharmaceuticals Inc (per DailyMed), Morgantown, WV, 2016. DailyMed
- Product Information: Butorphanol tartrate intramuscular injection, intravenous injection, butorphanol tartrate intramuscular injection, intravenous injection. Hospira Inc (per DailyMed), Lake Forest, IL, 2016.
Keep reading about Doxepin
Keep reading about Butorphanol Nasal Spray
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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