butorphanol (Rx)

Brand and Other Names:Stadol
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution: Schedule IV

  • 1mg/mL
  • 2mg/mL

nasal spray: Schedule IV

  • 10 mg/mL (1mg/spray)
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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

Geriatric Dosing

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

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

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Interactions

Interaction Checker

and butorphanol

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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

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            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

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            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.

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            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)

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            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

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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