Details of the Drug

General Information of Drug (ID: DM5KYPJ)

Drug Name

Butorphanol

Synonyms

Beforal; Butorfanol; Butorphanolum; Moradol; Stadol; Butorphanol tartrate; BC-2627; Beforal (TN); Butorfanol [INN-Spanish]; Butorphanolum [INN-Latin]; L-BC 2627; Moradol (TN); Butorphanol (USAN/INN); Butorphanol [USAN:BAN:INN]; Levo-BC-2627; (-)-17-(Cyclobutylmethyl)morphinan-3,14-diol; (-)-N-cyclobutylmethyl-3,14-dihydroxymorphinan; (-)-butorphanol; 17-(CYCLOBUTYLMETHYL)MORPHINAN-3,14-DIOL

Indication

Disease Entry	ICD 11	Status	REF
Pain	MG30-MG3Z	Approved	[1], [2]

Therapeutic Class

Analgesics

Drug Type

Small molecular drug

Structure

3D MOL

2D MOL

#Ro5 Violations (Lipinski): 0

Molecular Weight (mw)

327.5

Topological Polar Surface Area (xlogp)

3.8

Rotatable Bond Count (rotbonds)

Hydrogen Bond Donor Count (hbonddonor)

Hydrogen Bond Acceptor Count (hbondacc)

ADMET Property

BDDCS Class: Biopharmaceutics Drug Disposition Classification System (BDDCS) Class 1: high solubility and high permeability [3]
Clearance: The drug present in the plasma can be removed from the body at the rate of 41 mL/min/kg [4]
Elimination: 2% of drug is excreted from urine in the unchanged form [3]
Half-life: The concentration or amount of drug in body reduced by one-half in 18 hours [4]
Metabolism: The drug is metabolized via the liver [5]
MRTD: The Maximum Recommended Therapeutic Dose (MRTD) of drug that ensured maximising efficacy and moderate side effect is 0.81534 micromolar/kg/day [6]
Unbound Fraction: The unbound fraction of drug in plasma is 0.17% [4]
Vd: The volume of distribution (Vd) of drug is 305-901 L [7]
Water Solubility: The ability of drug to dissolve in water is measured as 2 mg/mL [3]

Chemical Identifiers

Formula: C21H29NO2
IUPAC Name: (1S,9R,10S)-17-(cyclobutylmethyl)-17-azatetracyclo[7.5.3.01,10.02,7]heptadeca-2(7),3,5-triene-4,10-diol
Canonical SMILES: C1CC[C@]2([C@H]3CC4=C([C@]2(C1)CCN3CC5CCC5)C=C(C=C4)O)O
InChI: InChI=1S/C21H29NO2/c23-17-7-6-16-12-19-21(24)9-2-1-8-20(21,18(16)13-17)10-11-22(19)14-15-4-3-5-15/h6-7,13,15,19,23-24H,1-5,8-12,14H2/t19-,20+,21-/m1/s1
InChIKey: IFKLAQQSCNILHL-QHAWAJNXSA-N

Cross-matching ID

PubChem CID: 5361092
ChEBI ID: CHEBI:3242
CAS Number: 42408-82-2
DrugBank ID: DB00611
TTD ID: D0X9RG

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Opioid receptor delta (OPRD1)	TT27RFC	OPRD_HUMAN	Agonist	[8]

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Molecular Interaction Atlas (MIA)

MIA Detail

Jump to Detail Molecular Interaction Atlas of This Drug

Molecular Expression Atlas of This Drug

The Studied Disease

Pain

ICD Disease Classification

MG30-MG3Z

Molecule Name	Molecule Type	Gene Name	p-value	Fold-Change	Z-score
Opioid receptor delta (OPRD1)	DTT	OPRD1	5.52E-01	0.03	0.23

Molecular Expression Atlas (MEA)

MEA Detail

Jump to Detail Molecular Expression Atlas of This Drug

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Same Disease as Butorphanol

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Disease	REF
Pentazocine	DM1XBHS	Major	Additive CNS depression effects by the combination of Butorphanol and Pentazocine.	Pain [MG30-MG3Z]	[18]
Dextropropoxyphene	DM23HCX	Major	Additive CNS depression effects by the combination of Butorphanol and Dextropropoxyphene.	Pain [MG30-MG3Z]	[19]
Oxymorphone	DM65AGJ	Major	Additive CNS depression effects by the combination of Butorphanol and Oxymorphone.	Pain [MG30-MG3Z]	[18]
Levorphanol	DMGS80V	Major	Additive CNS depression effects by the combination of Butorphanol and Levorphanol.	Pain [MG30-MG3Z]	[18]
Dezocine	DMJDB0Y	Major	Additive CNS depression effects by the combination of Butorphanol and Dezocine.	Pain [MG30-MG3Z]	[18]
Flavoxate	DMKV4NL	Moderate	Additive antimotility effects by the combination of Butorphanol and Flavoxate.	Pain [MG30-MG3Z]	[20]
Nalbuphine	DMOSQGU	Major	Additive hypotensive effects by the combination of Butorphanol and Nalbuphine.	Pain [MG30-MG3Z]	[18]
Buprenorphine	DMPRI8G	Major	Additive CNS depression effects by the combination of Butorphanol and Buprenorphine.	Pain [MG30-MG3Z]	[18]
Hydrocodone	DMQ2JO5	Major	Additive hypotensive effects by the combination of Butorphanol and Hydrocodone.	Pain [MG30-MG3Z]	[18]
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⏷ Show the Full List of 9 DDI Information of This Drug

Coadministration of a Drug Treating the Disease Different from Butorphanol (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Metreleptin	DM1NOEK	Moderate	Increased metabolism of Butorphanol caused by Metreleptin mediated induction of CYP450 enzyme.	Acute diabete complication [5A2Y]	[21]
Ivosidenib	DM8S6T7	Major	Increased metabolism of Butorphanol caused by Ivosidenib mediated induction of CYP450 enzyme.	Acute myeloid leukaemia [2A60]	[22]
Arn-509	DMT81LZ	Major	Increased metabolism of Butorphanol caused by Arn-509 mediated induction of CYP450 enzyme.	Acute myeloid leukaemia [2A60]	[22]
Oliceridine	DM6MDCF	Major	Additive hypotensive effects by the combination of Butorphanol and Oliceridine.	Acute pain [MG31]	[18]
Scopolamine	DMOM8AL	Moderate	Additive antimotility effects by the combination of Butorphanol and Scopolamine.	Addictive disorder [6C50-6C5Z]	[20]
Mitotane	DMU1GX0	Major	Increased metabolism of Butorphanol caused by Mitotane mediated induction of CYP450 enzyme.	Adrenal cancer [2D11]	[22]
Dronedarone	DMA8FS5	Major	Decreased metabolism of Butorphanol caused by Dronedarone mediated inhibition of CYP450 enzyme.	Angina pectoris [BA40]	[23]
Clorazepate	DMC3JST	Major	Additive CNS depression effects by the combination of Butorphanol and Clorazepate.	Anxiety disorder [6B00-6B0Z]	[24]
Methylphenobarbital	DMDSWAG	Major	Additive CNS depression effects by the combination of Butorphanol and Methylphenobarbital.	Anxiety disorder [6B00-6B0Z]	[25]
Chlormezanone	DMTWUXR	Major	Additive CNS depression effects by the combination of Butorphanol and Chlormezanone.	Anxiety disorder [6B00-6B0Z]	[26]
Oxazepam	DMXNZM4	Major	Additive CNS depression effects by the combination of Butorphanol and Oxazepam.	Anxiety disorder [6B00-6B0Z]	[26]
Posaconazole	DMUL5EW	Major	Decreased metabolism of Butorphanol caused by Posaconazole mediated inhibition of CYP450 enzyme.	Aspergillosis [1F20]	[23]
Desipramine	DMT2FDC	Moderate	Additive CNS depression effects by the combination of Butorphanol and Desipramine.	Attention deficit hyperactivity disorder [6A05]	[27]
Oritavancin	DM28D05	Moderate	Increased metabolism of Butorphanol caused by Oritavancin mediated induction of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[21]
Dalfopristin	DM4LTKV	Major	Decreased metabolism of Butorphanol caused by Dalfopristin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[23]
Clarithromycin	DM4M1SG	Major	Decreased metabolism of Butorphanol caused by Clarithromycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[23]
Troleandomycin	DMUZNIG	Major	Decreased metabolism of Butorphanol caused by Troleandomycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[23]
Telithromycin	DMZ4P3A	Major	Decreased metabolism of Butorphanol caused by Telithromycin mediated inhibition of CYP450 enzyme.	Bacterial infection [1A00-1C4Z]	[23]
Cariprazine	DMJYDVK	Major	Additive CNS depression effects by the combination of Butorphanol and Cariprazine.	Bipolar disorder [6A60]	[26]
Pexidartinib	DMS2J0Z	Major	Increased metabolism of Butorphanol caused by Pexidartinib mediated induction of CYP450 enzyme.	Bone/articular cartilage neoplasm [2F7B]	[22]
Loperamide	DMOJZQ9	Moderate	Additive CNS depression effects by the combination of Butorphanol and Loperamide.	Bowel habit change [ME05]	[28]
Tucatinib	DMBESUA	Major	Decreased metabolism of Butorphanol caused by Tucatinib mediated inhibition of CYP450 enzyme.	Breast cancer [2C60-2C6Y]	[23]
Phenylbutazone	DMAYL0T	Moderate	Increased metabolism of Butorphanol caused by Phenylbutazone mediated induction of CYP450 enzyme.	Chronic pain [MG30]	[21]
Dihydrocodeine	DMB0FWL	Major	Additive hypotensive effects by the combination of Butorphanol and Dihydrocodeine.	Chronic pain [MG30]	[18]
Levomilnacipran	DMV26S8	Moderate	Additive serotonergic effects by the combination of Butorphanol and Levomilnacipran.	Chronic pain [MG30]	[27]
Olopatadine	DMKMWQG	Moderate	Additive CNS depression effects by the combination of Butorphanol and Olopatadine.	Conjunctiva disorder [9A60]	[29]
Propofol	DMB4OLE	Moderate	Additive CNS depression effects by the combination of Butorphanol and Propofol.	Corneal disease [9A76-9A78]	[30]
Mifepristone	DMGZQEF	Major	Decreased metabolism of Butorphanol caused by Mifepristone mediated inhibition of CYP450 enzyme.	Cushing syndrome [5A70]	[23]
Lumacaftor	DMCLWDJ	Major	Increased metabolism of Butorphanol caused by Lumacaftor mediated induction of CYP450 enzyme.	Cystic fibrosis [CA25]	[31]
Ethanol	DMDRQZU	Moderate	Additive CNS depression effects by the combination of Butorphanol and Ethanol.	Cystitis [GC00]	[32]
MK-8228	DMOB58Q	Major	Decreased metabolism of Butorphanol caused by MK-8228 mediated inhibition of CYP450 enzyme.	Cytomegaloviral disease [1D82]	[23]
Aprepitant	DM053KT	Major	Decreased metabolism of Butorphanol caused by Aprepitant mediated inhibition of CYP450 enzyme.	Depression [6A70-6A7Z]	[23]
Sertraline	DM0FB1J	Moderate	Additive CNS depression effects by the combination of Butorphanol and Sertraline.	Depression [6A70-6A7Z]	[27]
Trimipramine	DM1SC8M	Moderate	Additive CNS depression effects by the combination of Butorphanol and Trimipramine.	Depression [6A70-6A7Z]	[27]
Cyclobenzaprine	DM1YBRM	Major	Additive CNS depression effects by the combination of Butorphanol and Cyclobenzaprine.	Depression [6A70-6A7Z]	[26]
Vilazodone	DM4LECQ	Moderate	Additive CNS depression effects by the combination of Butorphanol and Vilazodone.	Depression [6A70-6A7Z]	[27]
Nefazodone	DM4ZS8M	Major	Decreased metabolism of Butorphanol caused by Nefazodone mediated inhibition of CYP450 enzyme.	Depression [6A70-6A7Z]	[23]
Paroxetine	DM5PVQE	Moderate	Additive serotonergic effects by the combination of Butorphanol and Paroxetine.	Depression [6A70-6A7Z]	[27]
Vortioxetine	DM6F1PU	Moderate	Additive CNS depression effects by the combination of Butorphanol and Vortioxetine.	Depression [6A70-6A7Z]	[27]
Milnacipran	DMBFE74	Moderate	Additive serotonergic effects by the combination of Butorphanol and Milnacipran.	Depression [6A70-6A7Z]	[27]
Escitalopram	DMFK9HG	Moderate	Additive serotonergic effects by the combination of Butorphanol and Escitalopram.	Depression [6A70-6A7Z]	[27]
Desvenlafaxine	DMHD4PE	Moderate	Additive CNS depression effects by the combination of Butorphanol and Desvenlafaxine.	Depression [6A70-6A7Z]	[27]
OPC-34712	DMHG57U	Major	Additive CNS depression effects by the combination of Butorphanol and OPC-34712.	Depression [6A70-6A7Z]	[26]
Clomipramine	DMINRKW	Moderate	Additive CNS depression effects by the combination of Butorphanol and Clomipramine.	Depression [6A70-6A7Z]	[27]
Trazodone	DMK1GBJ	Moderate	Additive CNS depression effects by the combination of Butorphanol and Trazodone.	Depression [6A70-6A7Z]	[27]
Doxepin	DMPI98T	Moderate	Additive serotonergic effects by the combination of Butorphanol and Doxepin.	Depression [6A70-6A7Z]	[27]
Maprotiline	DMPWB7T	Moderate	Additive serotonergic effects by the combination of Butorphanol and Maprotiline.	Depression [6A70-6A7Z]	[27]
Esketamine	DMVU687	Moderate	Additive CNS depression effects by the combination of Butorphanol and Esketamine.	Depression [6A70-6A7Z]	[33]
Mepenzolate	DM8YU2F	Moderate	Additive antimotility effects by the combination of Butorphanol and Mepenzolate.	Digestive system disease [DE2Z]	[20]
5-hydroxy-L-tryptophan	DMDWZGJ	Moderate	Additive serotonergic effects by the combination of Butorphanol and 5-hydroxy-L-tryptophan.	Discovery agent [N.A.]	[27]
Oxybutynine	DMJPBAX	Moderate	Additive antimotility effects by the combination of Butorphanol and Oxybutynine.	Discovery agent [N.A.]	[20]
Heroin diacetylmorphine	DMDBWHY	Major	Additive CNS depression effects by the combination of Butorphanol and Heroin diacetylmorphine.	Dissociative neurological symptom disorder [6B60]	[24]
Diazepam	DM08E9O	Major	Additive CNS depression effects by the combination of Butorphanol and Diazepam.	Epilepsy/seizure [8A61-8A6Z]	[26]
Primidone	DM0WX6I	Major	Increased metabolism of Butorphanol caused by Primidone mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[20]
Felbamate	DM1V5ZS	Moderate	Increased metabolism of Butorphanol caused by Felbamate mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[21]
Oxcarbazepine	DM5PU6O	Major	Increased metabolism of Butorphanol caused by Oxcarbazepine mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[33]
Gabapentin	DM6T924	Major	Additive CNS depression effects by the combination of Butorphanol and Gabapentin.	Epilepsy/seizure [8A61-8A6Z]	[34]
Cenobamate	DMGOVHA	Major	Increased metabolism of Butorphanol caused by Cenobamate mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[22]
Stiripentol	DMMSDOY	Major	Decreased metabolism of Butorphanol caused by Stiripentol mediated inhibition of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[23]
Fosphenytoin	DMOX3LB	Major	Increased metabolism of Butorphanol caused by Fosphenytoin mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[33]
Clonazepam	DMTO13J	Major	Additive CNS depression effects by the combination of Butorphanol and Clonazepam.	Epilepsy/seizure [8A61-8A6Z]	[26]
Rufinamide	DMWE60C	Moderate	Increased metabolism of Butorphanol caused by Rufinamide mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[21]
Phenobarbital	DMXZOCG	Major	Increased metabolism of Butorphanol caused by Phenobarbital mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[20]
Eslicarbazepine	DMZREFQ	Major	Increased metabolism of Butorphanol caused by Eslicarbazepine mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[33]
Dantrolene	DM1D8XY	Major	Additive CNS depression effects by the combination of Butorphanol and Dantrolene.	Fever [MG26]	[26]
Tazemetostat	DMWP1BH	Moderate	Increased metabolism of Butorphanol caused by Tazemetostat mediated induction of CYP450 enzyme.	Follicular lymphoma [2A80]	[21]
Solifenacin	DMG592Q	Moderate	Additive antimotility effects by the combination of Butorphanol and Solifenacin.	Functional bladder disorder [GC50]	[20]
Tolterodine	DMSHPW8	Moderate	Additive antimotility effects by the combination of Butorphanol and Tolterodine.	Functional bladder disorder [GC50]	[20]
Itraconazole	DMCR1MV	Major	Decreased metabolism of Butorphanol caused by Itraconazole mediated inhibition of CYP450 enzyme.	Fungal infection [1F29-1F2F]	[23]
Miconazole	DMPMYE8	Moderate	Decreased metabolism of Butorphanol caused by Miconazole mediated inhibition of CYP450 enzyme.	Fungal infection [1F29-1F2F]	[35]
Ketoconazole	DMPZI3Q	Major	Decreased metabolism of Butorphanol caused by Ketoconazole mediated inhibition of CYP450 enzyme.	Fungal infection [1F29-1F2F]	[23]
Propantheline	DM2EN6G	Moderate	Additive antimotility effects by the combination of Butorphanol and Propantheline.	Gastric ulcer [DA60]	[20]
Sulfinpyrazone	DMEV954	Moderate	Increased metabolism of Butorphanol caused by Sulfinpyrazone mediated induction of CYP450 enzyme.	Gout [FA25]	[21]
Boceprevir	DMBSHMF	Major	Decreased metabolism of Butorphanol caused by Boceprevir mediated inhibition of CYP450 enzyme.	Hepatitis virus infection [1E50-1E51]	[23]
Telaprevir	DMMRV29	Major	Decreased metabolism of Butorphanol caused by Telaprevir mediated inhibition of CYP450 enzyme.	Hepatitis virus infection [1E50-1E51]	[23]
Rifampin	DMA8J1G	Major	Increased metabolism of Butorphanol caused by Rifampin mediated induction of CYP450 enzyme.	HIV-infected patients with tuberculosis [1B10-1B14]	[31]
Rifapentine	DMCHV4I	Major	Increased metabolism of Butorphanol caused by Rifapentine mediated induction of CYP450 enzyme.	HIV-infected patients with tuberculosis [1B10-1B14]	[22]
Delavirdine	DM3NF5G	Major	Decreased metabolism of Butorphanol caused by Delavirdine mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[23]
Cobicistat	DM6L4H2	Major	Decreased metabolism of Butorphanol caused by Cobicistat mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[23]
Efavirenz	DMC0GSJ	Major	Increased metabolism of Butorphanol caused by Efavirenz mediated induction of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[22]
Saquinavir	DMG814N	Major	Decreased metabolism of Butorphanol caused by Saquinavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[23]
Etravirine	DMGV8QU	Major	Increased metabolism of Butorphanol caused by Etravirine mediated induction of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[22]
Amprenavir	DMLMXE0	Major	Decreased metabolism of Butorphanol caused by Amprenavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[23]
Darunavir	DMN3GCH	Major	Decreased metabolism of Butorphanol caused by Darunavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[23]
Atazanavir	DMSYRBX	Major	Decreased metabolism of Butorphanol caused by Atazanavir mediated inhibition of CYP450 enzyme.	Human immunodeficiency virus disease [1C60-1C62]	[23]
Verapamil	DMA7PEW	Major	Decreased metabolism of Butorphanol caused by Verapamil mediated inhibition of CYP450 enzyme.	Hypertension [BA00-BA04]	[23]
Conivaptan	DM1V329	Major	Decreased metabolism of Butorphanol caused by Conivaptan mediated inhibition of CYP450 enzyme.	Hypo-osmolality/hyponatraemia [5C72]	[23]
Lesinurad	DMUR64T	Moderate	Increased metabolism of Butorphanol caused by Lesinurad mediated induction of CYP450 enzyme.	Inborn purine/pyrimidine/nucleotide metabolism error [5C55]	[21]
Belladonna	DM2RBWK	Moderate	Additive antimotility effects by the combination of Butorphanol and Belladonna.	Infectious gastroenteritis/colitis [1A40]	[20]
Suvorexant	DM0E6S3	Major	Additive CNS depression effects by the combination of Butorphanol and Suvorexant.	Insomnia [7A00-7A0Z]	[26]
Amobarbital	DM0GQ8N	Major	Increased metabolism of Butorphanol caused by Amobarbital mediated induction of CYP450 enzyme.	Insomnia [7A00-7A0Z]	[20]
Ramelteon	DM7IW9J	Major	Additive CNS depression effects by the combination of Butorphanol and Ramelteon.	Insomnia [7A00-7A0Z]	[26]
Flurazepam	DMAL4G0	Major	Additive CNS depression effects by the combination of Butorphanol and Flurazepam.	Insomnia [7A00-7A0Z]	[26]
Triazolam	DMETYK5	Major	Additive CNS depression effects by the combination of Butorphanol and Triazolam.	Insomnia [7A00-7A0Z]	[26]
Zaleplon	DMGFWSM	Major	Additive CNS depression effects by the combination of Butorphanol and Zaleplon.	Insomnia [7A00-7A0Z]	[26]
Propiomazine	DMKY8V1	Major	Additive CNS depression effects by the combination of Butorphanol and Propiomazine.	Insomnia [7A00-7A0Z]	[26]
Tasimelteon	DMLOQ1V	Major	Additive CNS depression effects by the combination of Butorphanol and Tasimelteon.	Insomnia [7A00-7A0Z]	[26]
Paraldehyde	DMOC1BX	Major	Additive CNS depression effects by the combination of Butorphanol and Paraldehyde.	Insomnia [7A00-7A0Z]	[26]
ITI-007	DMUQ1DO	Major	Additive CNS depression effects by the combination of Butorphanol and ITI-007.	Insomnia [7A00-7A0Z]	[26]
Quazepam	DMY4D87	Major	Additive CNS depression effects by the combination of Butorphanol and Quazepam.	Insomnia [7A00-7A0Z]	[26]
Estazolam	DMZGXUM	Major	Additive CNS depression effects by the combination of Butorphanol and Estazolam.	Insomnia [7A00-7A0Z]	[26]
Polyethylene glycol	DM4I1JP	Moderate	Increased risk of lowers seizure threshold by the combination of Butorphanol and Polyethylene glycol.	Irritable bowel syndrome [DD91]	[36]
Clidinium	DMUMQZ0	Moderate	Additive antimotility effects by the combination of Butorphanol and Clidinium.	Irritable bowel syndrome [DD91]	[20]
Dicyclomine	DMZSDGX	Moderate	Additive antimotility effects by the combination of Butorphanol and Dicyclomine.	Irritable bowel syndrome [DD91]	[20]
Remimazolam	DMLVSYX	Major	Additive CNS depression effects by the combination of Butorphanol and Remimazolam.	Labour/delivery anaesthesia complication [JB0C]	[26]
Crizotinib	DM4F29C	Major	Decreased metabolism of Butorphanol caused by Crizotinib mediated inhibition of CYP450 enzyme.	Lung cancer [2C25]	[23]
Brigatinib	DM7W94S	Moderate	Increased metabolism of Butorphanol caused by Brigatinib mediated induction of CYP450 enzyme.	Lung cancer [2C25]	[21]
PF-06463922	DMKM7EW	Major	Increased metabolism of Butorphanol caused by PF-06463922 mediated induction of CYP450 enzyme.	Lung cancer [2C25]	[22]
Idelalisib	DM602WT	Major	Decreased metabolism of Butorphanol caused by Idelalisib mediated inhibition of CYP450 enzyme.	Mature B-cell leukaemia [2A82]	[23]
Vemurafenib	DM62UG5	Moderate	Increased metabolism of Butorphanol caused by Vemurafenib mediated induction of CYP450 enzyme.	Melanoma [2C30]	[21]
Dabrafenib	DMX6OE3	Major	Increased metabolism of Butorphanol caused by Dabrafenib mediated induction of CYP450 enzyme.	Melanoma [2C30]	[22]
Allopregnanolone	DMNLHAC	Moderate	Additive CNS depression effects by the combination of Butorphanol and Allopregnanolone.	Mental/behavioural/neurodevelopmental disorder [6E20-6E8Z]	[37]
Almogran	DM7I64Z	Moderate	Additive CNS depression effects by the combination of Butorphanol and Almogran.	Migraine [8A80]	[27]
Frovatriptan	DM7RE8P	Moderate	Additive CNS depression effects by the combination of Butorphanol and Frovatriptan.	Migraine [8A80]	[27]
Rizatriptan	DMDJMA3	Moderate	Additive CNS depression effects by the combination of Butorphanol and Rizatriptan.	Migraine [8A80]	[27]
Naratriptan	DMO50U2	Moderate	Additive serotonergic effects by the combination of Butorphanol and Naratriptan.	Migraine [8A80]	[27]
Sumatriptan	DMVYXR8	Moderate	Additive CNS depression effects by the combination of Butorphanol and Sumatriptan.	Migraine [8A80]	[27]
Lasmiditan	DMXLVDT	Moderate	Additive CNS depression effects by the combination of Butorphanol and Lasmiditan.	Migraine [8A80]	[38]
Exjade	DMHPRWG	Moderate	Increased metabolism of Butorphanol caused by Exjade mediated induction of CYP450 enzyme.	Mineral absorption/transport disorder [5C64]	[21]
Flibanserin	DM70DTN	Moderate	Additive CNS depression effects by the combination of Butorphanol and Flibanserin.	Mood disorder [6A60-6E23]	[39]
Thalidomide	DM70BU5	Moderate	Additive CNS depression effects by the combination of Butorphanol and Thalidomide.	Multiple myeloma [2A83]	[40]
Rifabutin	DM1YBHK	Major	Increased metabolism of Butorphanol caused by Rifabutin mediated induction of CYP450 enzyme.	Mycobacterium infection [1B10-1B21]	[22]
Imatinib	DM7RJXL	Major	Decreased metabolism of Butorphanol caused by Imatinib mediated inhibition of CYP450 enzyme.	Myeloproliferative neoplasm [2A20]	[23]
Prasugrel	DM7MT6E	Moderate	Altered absorption of Butorphanol due to GI dynamics variation caused by Prasugrel.	Myocardial infarction [BA41-BA43]	[41]
Modafinil	DMYILBE	Major	Increased metabolism of Butorphanol caused by Modafinil mediated induction of CYP450 enzyme.	Narcolepsy [7A20]	[22]
Netupitant	DMEKAYI	Major	Decreased metabolism of Butorphanol caused by Netupitant mediated inhibition of CYP450 enzyme.	Nausea/vomiting [MD90]	[23]
Metoclopramide	DMFA5MY	Moderate	Additive antimotility effects by the combination of Butorphanol and Metoclopramide.	Nausea/vomiting [MD90]	[42]
Granisetron	DMIUW25	Moderate	Additive CNS depression effects by the combination of Butorphanol and Granisetron.	Nausea/vomiting [MD90]	[27]
Dolasetron	DMMG26Z	Moderate	Additive CNS depression effects by the combination of Butorphanol and Dolasetron.	Nausea/vomiting [MD90]	[27]
Ondansetron	DMOTQ1I	Moderate	Additive serotonergic effects by the combination of Butorphanol and Ondansetron.	Nausea/vomiting [MD90]	[27]
Bupropion	DM5PCS7	Major	Increased risk of lowers seizure threshold by the combination of Butorphanol and Bupropion.	Nicotine use disorder [6C4A]	[43]
Sibutramine	DMFJTDI	Moderate	Additive CNS depression effects by the combination of Butorphanol and Sibutramine.	Obesity [5B80-5B81]	[27]
Dexfenfluramine	DMJ7YDS	Moderate	Additive CNS depression effects by the combination of Butorphanol and Dexfenfluramine.	Obesity [5B80-5B81]	[27]
Levomethadyl Acetate	DM06HG5	Major	Additive hypotensive effects by the combination of Butorphanol and Levomethadyl Acetate.	Opioid use disorder [6C43]	[18]
Apraclonidine	DMO4PVE	Moderate	Additive CNS depression effects by the combination of Butorphanol and Apraclonidine.	Optic nerve disorder [9C40]	[44]
Biperiden	DME78OA	Moderate	Additive CNS depression effects by the combination of Butorphanol and Biperiden.	Parkinsonism [8A00]	[45]
Pimavanserin	DMR7IVC	Major	Additive CNS depression effects by the combination of Butorphanol and Pimavanserin.	Parkinsonism [8A00]	[26]
Orphenadrine	DMW542E	Major	Additive CNS depression effects by the combination of Butorphanol and Orphenadrine.	Parkinsonism [8A00]	[26]
Methylscopolamine	DM5VWOB	Moderate	Additive antimotility effects by the combination of Butorphanol and Methylscopolamine.	Peptic ulcer [DA61]	[20]
Lonafarnib	DMGM2Z6	Major	Decreased metabolism of Butorphanol caused by Lonafarnib mediated inhibition of CYP450 enzyme.	Premature ageing appearance [LD2B]	[23]
Enzalutamide	DMGL19D	Major	Increased metabolism of Butorphanol caused by Enzalutamide mediated induction of CYP450 enzyme.	Prostate cancer [2C82]	[22]
Fluphenazine	DMIT8LX	Major	Additive CNS depression effects by the combination of Butorphanol and Fluphenazine.	Psychotic disorder [6A20-6A25]	[46]
Dexamethasone	DMMWZET	Major	Increased metabolism of Butorphanol caused by Dexamethasone mediated induction of CYP450 enzyme.	Rheumatoid arthritis [FA20]	[22]
Quetiapine	DM1N62C	Major	Additive CNS depression effects by the combination of Butorphanol and Quetiapine.	Schizophrenia [6A20]	[46]
Mesoridazine	DM2ZGAN	Major	Additive CNS depression effects by the combination of Butorphanol and Mesoridazine.	Schizophrenia [6A20]	[46]
Thioridazine	DM35M8J	Major	Additive CNS depression effects by the combination of Butorphanol and Thioridazine.	Schizophrenia [6A20]	[26]
Aripiprazole	DM3NUMH	Major	Additive CNS depression effects by the combination of Butorphanol and Aripiprazole.	Schizophrenia [6A20]	[26]
Iloperidone	DM6AUFY	Major	Additive CNS depression effects by the combination of Butorphanol and Iloperidone.	Schizophrenia [6A20]	[26]
Paliperidone	DM7NPJS	Major	Additive CNS depression effects by the combination of Butorphanol and Paliperidone.	Schizophrenia [6A20]	[26]
Perphenazine	DMA4MRX	Major	Additive CNS depression effects by the combination of Butorphanol and Perphenazine.	Schizophrenia [6A20]	[26]
Molindone	DMAH70G	Major	Additive CNS depression effects by the combination of Butorphanol and Molindone.	Schizophrenia [6A20]	[26]
Thiothixene	DMDINC4	Major	Additive CNS depression effects by the combination of Butorphanol and Thiothixene.	Schizophrenia [6A20]	[46]
Trifluoperazine	DMKBYWI	Major	Additive CNS depression effects by the combination of Butorphanol and Trifluoperazine.	Schizophrenia [6A20]	[26]
Risperidone	DMN6DXL	Major	Additive CNS depression effects by the combination of Butorphanol and Risperidone.	Schizophrenia [6A20]	[26]
Asenapine	DMSQZE2	Major	Additive CNS depression effects by the combination of Butorphanol and Asenapine.	Schizophrenia [6A20]	[26]
Pimozide	DMW83TP	Major	Additive CNS depression effects by the combination of Butorphanol and Pimozide.	Schizophrenia [6A20]	[26]
Fentanyl	DM8WAHT	Major	Additive CNS depression effects by the combination of Butorphanol and Fentanyl.	Sensation disturbance [MB40]	[18]
Voxelotor	DMCS6M5	Major	Decreased metabolism of Butorphanol caused by Voxelotor mediated inhibition of CYP450 enzyme.	Sickle-cell disorder [3A51]	[23]
Telotristat ethyl	DMDIYFZ	Major	Increased metabolism of Butorphanol caused by Telotristat ethyl mediated induction of CYP450 enzyme.	Small intestine developmental anomaly [DA90]	[31]
Armodafinil	DMGB035	Major	Increased metabolism of Butorphanol caused by Armodafinil mediated induction of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[22]
LEE011	DMMX75K	Major	Decreased metabolism of Butorphanol caused by LEE011 mediated inhibition of CYP450 enzyme.	Solid tumour/cancer [2A00-2F9Z]	[23]
Brilinta	DMBR01X	Moderate	Altered absorption of Butorphanol due to GI dynamics variation caused by Brilinta.	Thrombosis [DB61-GB90]	[41]
Clopidogrel	DMOL54H	Moderate	Altered absorption of Butorphanol due to GI dynamics variation caused by Clopidogrel.	Thrombosis [DB61-GB90]	[41]
Tizanidine	DMR2IQ4	Major	Additive CNS depression effects by the combination of Butorphanol and Tizanidine.	Tonus and reflex abnormality [MB47]	[26]
Elagolix	DMB2C0E	Major	Increased metabolism of Butorphanol caused by Elagolix mediated induction of CYP450 enzyme.	Uterine fibroid [2E86]	[22]
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References

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37	Product Information. Zulresso (brexanolone). Sage Therapeutics, Inc., Cambridge, MA.
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