Alvimopan (Entereg) should not be combined with butorphanol because it increases levels of butorphanol.
Butorphanol should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Butorphanol should not be administered within 14 days of stopping an MAOI.
PREGNANCY: Butorphanol is a Category C drug and is approved for pain management during pregnancy. It crosses the placenta and may affect the newborn's heart beat and breathing, so low doses and careful monitoring is recommended. Chronic exposure may lead to withdrawal symptoms.
NURSING MOTHERS: Butorphanol is excreted in breast milk. The amount that the infant may receive is very low and insignificant.
SIDE EFFECTS: The most frequent adverse reactions include drowsiness, dizziness, nausea, vomiting, and nasal congestion and insomnia with the nasal preparation. Patients may also experience palpitations, flushing, anxiety, confusion, euphoria, headache, nervousness, tingling sensation in limbs, cold/clammy skin, sweating, itchiness, anorexia, constipation, stomach pain, dry mouth, tremor, weakness, blurred vision, ringing in ears, and difficulty breathing. Butorphanol is habit forming. Mental and physical dependence can occur when used long-term.
FDA Prescribing Information.
Medscape. butorphanol (Rx) - Stadol.
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