Dosing & Uses
Dosage Forms & Strengths
injectable solution: Schedule IV
- 1mg/mL
- 2mg/mL
nasal spray: Schedule IV
- 10 mg/mL (1mg/spray)
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
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
Pain
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- alvimopan
alvimopan, butorphanol. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.
Serious - Use Alternative (51)
- alfentanil
butorphanol, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- belladonna and opium
butorphanol, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
butorphanol decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients. - buprenorphine
buprenorphine, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- buprenorphine buccal
buprenorphine buccal, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- calcium/magnesium/potassium/sodium oxybates
butorphanol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- cimetidine
cimetidine increases effects of butorphanol by decreasing metabolism. Avoid or Use Alternate Drug.
- clonidine
clonidine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.
- codeine
butorphanol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- dextromoramide
butorphanol, dextromoramide. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diamorphine
butorphanol, diamorphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diazepam intranasal
diazepam intranasal, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- difenoxin hcl
butorphanol, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diphenoxylate hcl
butorphanol, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- dipipanone
butorphanol, dipipanone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- eluxadoline
butorphanol, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .
- fentanyl
fentanyl, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl intranasal
fentanyl intranasal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl transdermal
fentanyl transdermal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl transmucosal
fentanyl transmucosal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
butorphanol decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - hydrocodone
butorphanol decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.
hydrocodone, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - hydromorphone
butorphanol, hydromorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- isocarboxazid
isocarboxazid increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- levorphanol
butorphanol, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- linezolid
linezolid increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- meperidine
butorphanol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- methadone
butorphanol, methadone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- methylene blue
methylene blue and butorphanol both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities
- metoclopramide intranasal
butorphanol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- morphine
butorphanol, morphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- nalbuphine
butorphanol, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oliceridine
butorphanol, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.
- olopatadine intranasal
butorphanol and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- opium tincture
butorphanol, opium tincture. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxycodone
butorphanol, oxycodone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxymorphone
butorphanol, oxymorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- ozanimod
ozanimod and butorphanol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- papaveretum
butorphanol, papaveretum. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- pentazocine
butorphanol, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- phenelzine
phenelzine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- procarbazine
procarbazine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of additive CNS, respiratory and hypotensive effects. .
- rasagiline
rasagiline increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. May cause additive CNS depression, drowsiness, dizziness or hypotension, so use with MAOIs should be cautious; lower initial dosages of the analgesic are recommended followed by careful titration. Avoid combination within 14 days of MAOI use.
- selegiline transdermal
selegiline transdermal increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
selinexor, butorphanol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sodium oxybate
butorphanol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sufentanil
butorphanol, sufentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- sufentanil SL
butorphanol decreases effects of sufentanil SL by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of opioid mixed agonist/antagonist or partial agonist may reduce sufentail SL analgesic effect and/or precipitate withdrawal symptoms.
sufentanil SL, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - tapentadol
butorphanol, tapentadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- tramadol
tramadol, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.
butorphanol, tramadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx. - tranylcypromine
tranylcypromine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- valerian
valerian and butorphanol both increase sedation. Avoid or Use Alternate Drug.
Monitor Closely (190)
- albuterol
butorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and butorphanol both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and butorphanol both increase sedation. Use Caution/Monitor.
- amitriptyline
butorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- amoxapine
butorphanol and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
butorphanol and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
butorphanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
butorphanol and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
butorphanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- azelastine
azelastine and butorphanol both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and butorphanol both increase sedation. Use Caution/Monitor.
- belladonna and opium
butorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.
- benperidol
butorphanol and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
butorphanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexanolone
brexanolone, butorphanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and butorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and butorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and butorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
butorphanol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and butorphanol both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
butorphanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and butorphanol both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and butorphanol both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and butorphanol both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and butorphanol both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.
- chlorpromazine
butorphanol and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and butorphanol both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and butorphanol both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and butorphanol both increase sedation. Use Caution/Monitor.
- clobazam
butorphanol, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
butorphanol and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and butorphanol both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and butorphanol both increase sedation. Use Caution/Monitor.
- clozapine
butorphanol and clozapine both increase sedation. Use Caution/Monitor.
- codeine
butorphanol and codeine both increase sedation. Use Caution/Monitor.
- cyclizine
cyclizine and butorphanol both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and butorphanol both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and butorphanol both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and butorphanol both increase sedation. Use Caution/Monitor.
- daridorexant
butorphanol and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desflurane
desflurane and butorphanol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
butorphanol and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
butorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.
- dexfenfluramine
butorphanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and butorphanol both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
butorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
butorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
butorphanol and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
butorphanol and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and butorphanol both increase sedation. Use Caution/Monitor.
- diethylpropion
butorphanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and butorphanol both increase sedation. Use Caution/Monitor.
- difenoxin hcl
butorphanol and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and butorphanol both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and butorphanol both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
butorphanol and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
butorphanol and dipipanone both increase sedation. Use Caution/Monitor.
- dobutamine
butorphanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
butorphanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
butorphanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
butorphanol and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
butorphanol and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and butorphanol both increase sedation. Use Caution/Monitor.
- droperidol
butorphanol and droperidol both increase sedation. Use Caution/Monitor.
- ephedrine
butorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
butorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
butorphanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, butorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and butorphanol both increase sedation. Use Caution/Monitor.
- ethanol
butorphanol and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and butorphanol both increase sedation. Use Caution/Monitor.
- fenfluramine
butorphanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
butorphanol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
butorphanol and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and butorphanol both increase sedation. Use Caution/Monitor.
- formoterol
butorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gabapentin
gabapentin, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- ganaxolone
butorphanol and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
butorphanol and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
butorphanol and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and butorphanol both increase sedation. Use Caution/Monitor.
- iloperidone
butorphanol and iloperidone both increase sedation. Use Caution/Monitor.
- imipramine
butorphanol and imipramine both increase sedation. Use Caution/Monitor.
- isoproterenol
butorphanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and butorphanol both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
butorphanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, butorphanol. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
butorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
butorphanol and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
butorphanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
butorphanol and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
butorphanol and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and butorphanol both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and butorphanol both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and butorphanol both increase sedation. Use Caution/Monitor.
- loxapine
butorphanol and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
butorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, butorphanol. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
butorphanol and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
butorphanol and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
butorphanol and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
butorphanol and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
butorphanol and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
butorphanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and butorphanol both increase sedation. Use Caution/Monitor.
- methadone
butorphanol and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
butorphanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and butorphanol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
butorphanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and butorphanol both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with opioids increases risk of respiratory depression. Use only when alternative treatment options are inadequate. Use minimum required dosing.
- midodrine
butorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
butorphanol and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
butorphanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
butorphanol and morphine both increase sedation. Use Caution/Monitor.
- motherwort
butorphanol and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
butorphanol and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
butorphanol and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
butorphanol and nalbuphine both increase sedation. Use Caution/Monitor.
- norepinephrine
butorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
butorphanol and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
butorphanol and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- opium tincture
butorphanol and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and butorphanol both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and butorphanol both increase sedation. Use Caution/Monitor.
- oxycodone
butorphanol and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
butorphanol and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
butorphanol and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
butorphanol and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
butorphanol and papaverine both increase sedation. Use Caution/Monitor.
- pegvisomant
butorphanol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
butorphanol and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- perampanel
perampanel and butorphanol both increase sedation. Use Caution/Monitor.
- perphenazine
butorphanol and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
butorphanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- phentermine
butorphanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
butorphanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
butorphanol increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
butorphanol and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
butorphanol and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
butorphanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and butorphanol both increase sedation. Use Caution/Monitor.
- prochlorperazine
butorphanol and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and butorphanol both increase sedation. Use Caution/Monitor.
- propofol
propofol and butorphanol both increase sedation. Use Caution/Monitor.
- propylhexedrine
butorphanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
butorphanol and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and butorphanol both increase sedation. Use Caution/Monitor.
- quetiapine
butorphanol and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
butorphanol and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, butorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- risperidone
butorphanol and risperidone both increase sedation. Use Caution/Monitor.
- salmeterol
butorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
butorphanol and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and butorphanol both increase sedation. Use Caution/Monitor.
- selegiline
selegiline increases toxicity of butorphanol by unknown mechanism. Use Caution/Monitor. Concomitant use of butorphanol with other CNS depressants can potentiate the effects of butorphanol on respiratory depression, CNS depression and sedation.hyperpyrexia, somnolence, or death.
- sevoflurane
sevoflurane and butorphanol both increase sedation. Use Caution/Monitor.
- shepherd's purse
butorphanol and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concurrent use of medications with CNS depressant effects together with thalidomide should be avoided due to the risk for additive sedative effects.
- sufentanil
butorphanol and sufentanil both increase sedation. Use Caution/Monitor.
- suvorexant
suvorexant and butorphanol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
butorphanol and tapentadol both increase sedation. Use Caution/Monitor.
- temazepam
temazepam and butorphanol both increase sedation. Use Caution/Monitor.
- terbutaline
butorphanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
butorphanol and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
butorphanol and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
butorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
butorphanol and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
butorphanol and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and butorphanol both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and butorphanol both increase sedation. Use Caution/Monitor.
- trifluoperazine
butorphanol and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
butorphanol and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and butorphanol both increase sedation. Use Caution/Monitor.
- xylometazoline
butorphanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
butorphanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
butorphanol and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
butorphanol and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
butorphanol and zotepine both increase sedation. Use Caution/Monitor.
Minor (6)
- brimonidine
brimonidine increases effects of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- dextroamphetamine
dextroamphetamine increases effects of butorphanol by unspecified interaction mechanism. Minor/Significance Unknown.
- eucalyptus
butorphanol and eucalyptus both increase sedation. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- sage
butorphanol and sage both increase sedation. Minor/Significance Unknown.
- ziconotide
ziconotide, butorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
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
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
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.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)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| butorphanol nasal - | 10 mg/mL aerosol |  | |
| butorphanol nasal - | 10 mg/mL aerosol |  | |
| butorphanol nasal - | 10 mg/mL aerosol |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 1 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 1 mg/mL vial |  | |
| butorphanol injection - | 2 mg/mL vial |  | |
| butorphanol injection - | 1 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
butorphanol nasal
BUTORPHANOL TARTRATE - NASAL
(bue-TOR-fa-nol TAR-trate)
COMMON BRAND NAME(S): Stadol NS
WARNING: Butorphanol has a risk for abuse and addiction, which can lead to overdose and death. Butorphanol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you use the smallest dose of butorphanol that works, and use it for the shortest possible time. See also How to Use section for more information about addiction.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you use the wrong dose/strength. Using this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Also, other medications can affect the removal of butorphanol from your body, which may affect how butorphanol works. Be sure you know how to use butorphanol and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows or uses this drug, get medical help right away.Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, use the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
USES: This medication is used to treat moderate to severe pain, including pain from surgery, muscle pain, and migraine headaches. Butorphanol is an opioid pain reliever similar to morphine. It acts on certain centers in the brain to give you pain relief.Butorphanol can also block the effects of opioids and can cause withdrawal symptoms in people dependent on opioids. If possible, people who have recently used opioids in high doses or for a long time should not use butorphanol. (See also Side Effects section.)
HOW TO USE: Read the Medication Guide and the Patient Information Leaflet provided by your pharmacist before you start using butorphanol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is a nasal spray. Have your doctor or pharmacist show the proper way to use the nasal spray. For best results, blow your nose gently before using. Follow the patient instruction leaflet for priming the pump before first use. If the spray has not been used in 48 hours, you may need to prime the pump again before use.Use 1 spray in 1 nostril or as directed by your doctor. If you still have pain after 60-90 minutes, your doctor may direct you to use a second spray in the other nostril. If needed, butorphanol may be used again in 3-4 hours after the second spray or as directed by your doctor. Some people will need 2 sprays (1 in each nostril) at the same time. In this case, they should remain lying down because there is a higher risk of drowsiness and dizziness with this higher dose. Follow your doctor's directions carefully.The dosage is based on your medical condition and response to therapy. Do not increase the dose or use it more often than directed by your doctor. Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.This drug can cause a drop in blood pressure, especially within the first hour after use. This can cause dizziness, lightheadedness, and fainting. To lower this risk, remain sitting or lying down after using this medication.If you use a nasal decongestant spray (such as oxymetazoline), the decongestant may make this pain medication work more slowly. Ask your doctor or pharmacist about using these 2 medications.If you have nausea, ask your doctor or pharmacist about ways to decrease it (such as lying down for 1 to 2 hours with as little head movement as possible).Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Use this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.When used for an extended period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well.Tell your doctor if your pain does not get better or if it gets worse.
SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, blurred vision, flushing, headache, nausea, vomiting, constipation, nasal irritation/congestion, trouble sleeping, dry mouth, and sweating may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Butorphanol can cause withdrawal reactions in people who are physically dependent on opioids. The seriousness of the withdrawal symptoms depends on the level of dependence and the dose of butorphanol. Tell your doctor right away if you develop symptoms such as anxiety, agitation, trouble sleeping, sweating, stomach cramps, and diarrhea.Tell your doctor right away if you have any serious side effects, including: bleeding from the nose, interrupted breathing during sleep (sleep apnea), mental/mood changes (such as anxiety, confusion, hallucinations), fast/slow/irregular heartbeat, severe stomach/abdominal pain, difficulty urinating, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).Get medical help right away if you have any very serious side effects, including: difficult/slow/shallow breathing, severe drowsiness/difficulty waking up, seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using butorphanol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as benzethonium chloride), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: abdominal problems (such as gallbladder disease, pancreatitis), adrenal gland problems (such as Addison's disease), brain disorders (such as seizures, head injury, tumor, increased intracranial pressure), heart problems (such as irregular heartbeat, chest pain, recent heart attack), high blood pressure, kidney disease, liver disease, breathing problems (such as asthma, chronic obstructive pulmonary disease-COPD, sleep apnea), mental/mood disorders (such as toxic psychosis), a certain spinal problem (kyphoscoliosis), stomach/intestinal problems (such as diarrhea due to infection, paralytic ileus), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), difficulty urinating (such as due to enlarged prostate or urethral stricture), underactive thyroid (hypothyroidism).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness, drowsiness, and slow/shallow breathing.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)This drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), naltrexone, nasal decongestants (such as oxymetazoline), samidorphan.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is used with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Other medications can affect the removal of butorphanol from your body, which may affect how butorphanol works. Examples include azole antifungals (such as ketoconazole), macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin, rifampin), ritonavir, certain drugs used to treat seizures (such as carbamazepine, phenytoin), among others.This medication may interfere with certain laboratory tests (including amylase/lipase levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, coma.
NOTES: Do not share this medication with others. Sharing it is against the law.This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case.
MISSED DOSE: Not applicable.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised September 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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.
