Dosing & Uses
Dosage Forms & Strengths
tablet: Schedule II
- 2mg
Pain
Opiate-naive
- 2 mg PO q6-8hr PRN
- 1 mg IM/SC q6-8hr PRN
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24 hr PRN
Prior opiate exposure
- 2-4 mg PO q6-8hr PRN
- 1-2 mg IV/SC q6-8hr PRN
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24hr PRN
Premedication
1-2 mg/dose IM/SC 60-90 min prior to surgery
Renal Impairment
Use caution; reduce initial dose in severe renal impairment
Hepatic Impairment
Use caution; reduce initial dose in severe hepatic impairment
Other Indications & Uses
General anesthesia, local anesthesia
<18 yo: not recommended
Pain
Opiate-naive
- 2 mg PO q6-8hr PRN
- 1 mg IM/SC q6-8hr PRN
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24 hr PRN
Prior opiate exposure
- 2-4 mg PO q6-8hr PRN
- 1-2 mg IV/SC q6-8hr PRN
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24hr PRN
Premedication
1-2 mg/dose IM/SC 60-90 min prior to surgery
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- alvimopan
alvimopan, levorphanol. 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 (34)
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, levorphanol. 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.
- bremelanotide
bremelanotide will decrease the level or effect of levorphanol by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.
- buprenorphine
buprenorphine, 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.
- buprenorphine buccal
buprenorphine buccal, 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.
- butorphanol
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.
- calcium/magnesium/potassium/sodium oxybates
levorphanol, 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 levorphanol by decreasing metabolism. Avoid or Use Alternate Drug.
- desvenlafaxine
desvenlafaxine and levorphanol both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome
- diazepam intranasal
diazepam intranasal, levorphanol. 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.
- eluxadoline
levorphanol, 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, levorphanol. 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.
- fentanyl intranasal
fentanyl intranasal, levorphanol. 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.
- fentanyl transdermal
fentanyl transdermal, levorphanol. 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.
- fentanyl transmucosal
fentanyl transmucosal, levorphanol. 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.
- hydrocodone
hydrocodone, levorphanol. 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.
- isocarboxazid
isocarboxazid increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- linezolid
linezolid increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- methylene blue
methylene blue and levorphanol 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
levorphanol, 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.
- nalbuphine
nalbuphine, 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.
- olopatadine intranasal
levorphanol 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.
- ozanimod
ozanimod and levorphanol 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.
- pentazocine
pentazocine, 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.
- phenelzine
phenelzine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- procarbazine
procarbazine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .
- rasagiline
rasagiline increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selegiline transdermal
selegiline transdermal increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
selinexor, levorphanol. 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
levorphanol, 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 SL
sufentanil SL, levorphanol. 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.
- tramadol
tramadol, levorphanol. 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.
- tranylcypromine
tranylcypromine increases toxicity of levorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- valerian
valerian and levorphanol both increase sedation. Avoid or Use Alternate Drug.
- venlafaxine
venlafaxine and levorphanol both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome
Monitor Closely (200)
- acrivastine
acrivastine and levorphanol both increase sedation. Use Caution/Monitor.
- albuterol
levorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and levorphanol both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and levorphanol both increase sedation. Use Caution/Monitor.
- amisulpride
amisulpride and levorphanol both increase sedation. Use Caution/Monitor.
- amitriptyline
levorphanol and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and levorphanol both increase sedation. Use Caution/Monitor.
- amoxapine
levorphanol and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
levorphanol and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
levorphanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
levorphanol and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
levorphanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and levorphanol both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and levorphanol both increase sedation. Use Caution/Monitor.
- avapritinib
avapritinib and levorphanol both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and levorphanol both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and levorphanol both increase sedation. Use Caution/Monitor.
- belladonna and opium
levorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.
- benperidol
levorphanol and benperidol both increase sedation. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and levorphanol both increase sedation. Use Caution/Monitor.
- benzphetamine
levorphanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexanolone
brexanolone, levorphanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and levorphanol both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and levorphanol both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and levorphanol both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and levorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and levorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and levorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
buprenorphine subdermal implant and levorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine transdermal
buprenorphine transdermal and levorphanol both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
levorphanol 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.
buprenorphine, long-acting injection and levorphanol both increase sedation. Use Caution/Monitor. - butabarbital
butabarbital and levorphanol both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and levorphanol both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and levorphanol both increase sedation. Use Caution/Monitor.
- caffeine
levorphanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and levorphanol both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and levorphanol both increase sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and levorphanol both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and levorphanol both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and levorphanol both increase sedation. Use Caution/Monitor.
- chlorpromazine
levorphanol and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and levorphanol both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and levorphanol both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and levorphanol both increase sedation. Use Caution/Monitor.
- clobazam
levorphanol, 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
levorphanol and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and levorphanol both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and levorphanol both increase sedation. Use Caution/Monitor.
- clozapine
levorphanol and clozapine both increase sedation. Use Caution/Monitor.
- codeine
codeine and levorphanol both increase sedation. Use Caution/Monitor.
- cyclizine
cyclizine and levorphanol both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and levorphanol both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and levorphanol both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and levorphanol both increase sedation. Use Caution/Monitor.
- daridorexant
levorphanol 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 levorphanol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
levorphanol and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
levorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and levorphanol both increase sedation. Use Caution/Monitor.
- dexfenfluramine
levorphanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and levorphanol both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
levorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
levorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
dextromoramide and levorphanol both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and levorphanol both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and levorphanol both increase sedation. Use Caution/Monitor.
- diethylpropion
levorphanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and levorphanol both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and levorphanol both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and levorphanol both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and levorphanol both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl and levorphanol both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and levorphanol both increase sedation. Use Caution/Monitor.
- dobutamine
levorphanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
levorphanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
levorphanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
levorphanol and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
levorphanol and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and levorphanol both increase sedation. Use Caution/Monitor.
- droperidol
levorphanol and droperidol both increase sedation. Use Caution/Monitor.
- eltrombopag
eltrombopag increases levels of levorphanol by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.
- ephedrine
levorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
levorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
levorphanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, levorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and levorphanol both increase sedation. Use Caution/Monitor.
- ethanol
levorphanol and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and levorphanol both increase sedation. Use Caution/Monitor.
- fenfluramine
levorphanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
levorphanol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
levorphanol and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and levorphanol both increase sedation. Use Caution/Monitor.
- formoterol
levorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gabapentin
gabapentin, levorphanol. 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, levorphanol. 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
levorphanol and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
levorphanol and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
hydromorphone and levorphanol both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and levorphanol both increase sedation. Use Caution/Monitor.
- iloperidone
levorphanol and iloperidone both increase sedation. Use Caution/Monitor.
- imipramine
levorphanol and imipramine both increase sedation. Use Caution/Monitor.
- isoproterenol
levorphanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and levorphanol both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
levorphanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, levorphanol. 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, levorphanol. 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
levorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lisdexamfetamine
levorphanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
levorphanol and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
levorphanol and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and levorphanol both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and levorphanol both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and levorphanol both increase sedation. Use Caution/Monitor.
- loxapine
levorphanol and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
levorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, levorphanol. 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
levorphanol and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
levorphanol and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
levorphanol and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
levorphanol and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
levorphanol and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
levorphanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and levorphanol both increase sedation. Use Caution/Monitor.
- methadone
levorphanol and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
levorphanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and levorphanol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
levorphanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and levorphanol both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, levorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of benzodiazepines and opioids increases risk of respiratory depression. Use only in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required.
- midodrine
levorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
levorphanol and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
levorphanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
levorphanol and morphine both increase sedation. Use Caution/Monitor.
- motherwort
levorphanol and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
levorphanol and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
levorphanol and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
levorphanol and nalbuphine both increase sedation. Use Caution/Monitor.
- norepinephrine
levorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
levorphanol and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
levorphanol and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, levorphanol. 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
levorphanol and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and levorphanol both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and levorphanol both increase sedation. Use Caution/Monitor.
- oxycodone
levorphanol and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
levorphanol and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
levorphanol and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
levorphanol and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
levorphanol and papaverine both increase sedation. Use Caution/Monitor.
- pegvisomant
levorphanol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
levorphanol and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and levorphanol both increase sedation. Use Caution/Monitor.
- perampanel
perampanel and levorphanol both decrease sedation. Use Caution/Monitor.
- perphenazine
levorphanol and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
levorphanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and levorphanol both increase sedation. Use Caution/Monitor.
- phentermine
levorphanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
levorphanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pholcodine
levorphanol and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
levorphanol and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
levorphanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, levorphanol. 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 levorphanol both increase sedation. Use Caution/Monitor.
- prochlorperazine
levorphanol and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and levorphanol both increase sedation. Use Caution/Monitor.
- propofol
propofol and levorphanol both increase sedation. Use Caution/Monitor.
- propylhexedrine
levorphanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
levorphanol and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and levorphanol both increase sedation. Use Caution/Monitor.
- quetiapine
levorphanol and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
levorphanol and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, levorphanol. 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
levorphanol and risperidone both increase sedation. Use Caution/Monitor.
- salmeterol
levorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
levorphanol and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and levorphanol both increase sedation. Use Caution/Monitor.
- selegiline
selegiline increases toxicity of levorphanol by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.
- sevoflurane
sevoflurane and levorphanol both increase sedation. Use Caution/Monitor.
- shepherd's purse
levorphanol and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, levorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
- sufentanil
levorphanol and sufentanil both increase sedation. Use Caution/Monitor.
- suvorexant
suvorexant and levorphanol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
levorphanol and tapentadol both increase sedation. Use Caution/Monitor.
- temazepam
temazepam and levorphanol both increase sedation. Use Caution/Monitor.
- terbutaline
levorphanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
levorphanol and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
levorphanol and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
levorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
levorphanol and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
levorphanol and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and levorphanol both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and levorphanol both increase sedation. Use Caution/Monitor.
- trifluoperazine
levorphanol and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
levorphanol and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and levorphanol both increase sedation. Use Caution/Monitor.
- xylometazoline
levorphanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
levorphanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
levorphanol and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
levorphanol and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
levorphanol and zotepine both increase sedation. Use Caution/Monitor.
Minor (6)
- brimonidine
brimonidine increases effects of levorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- dextroamphetamine
dextroamphetamine increases effects of levorphanol by unspecified interaction mechanism. Minor/Significance Unknown.
- eucalyptus
levorphanol and eucalyptus both increase sedation. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of levorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- sage
levorphanol and sage both increase sedation. Minor/Significance Unknown.
- ziconotide
ziconotide, levorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
Adverse Effects
>10%
Dizziness
Hypoventilation
Nausea
Pruritus
1-10%
Hypotension
Constipation
Vomiting
Disturbance of consciousness
Disturbance in mood
<1%
Bradyarrhythmia
Cardiac arrest
Cardiac dysrhythmia
Palpitations
Tachyarrhythmia
Apnea
Warnings
Contraindications
Absolute: acute abdominal condition, pseudomembranous colitis, respiratory depression
Relative: asthma (acute), inflammatory bowel disease, respiratory impairment
Cautions
Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased intracranial pressure, prostatic hypertrophy, renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgery, toxin-mediated diarrhea
Pregnancy & Lactation
Pregnancy Category: B; D if used for prolonged periods or near term
Lactation: not known if excreted in breast milk
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 opiate receptors; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation
Pharmacokinetics
Half-Life: 12-16 hr
Onset of action: 10-60 min (PO)
Duration: 4-8 hr
Peak Plasma Time: 20 min (IV); 60-90 min (SC)
Metabolism: Liver (conjugation with glucuronic acid)
Excretion: Urine (primarily)
Administration
IV Incompatibilities
Additive: aminophylline, ammonium chloride, amobarbital, chlorothiazide, heparin, pentobarbital, phenobarbital, phenytoin, sodium bicarbonate, thiopental
IV Administration
IV: inject 3 mg over 4-5 min
Storage
Store at room temp
Protect from freezing
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| levorphanol tartrate oral - | 2 mg tablet |  | |
| levorphanol tartrate oral - | 2 mg tablet |  | |
| levorphanol tartrate oral - | 3 mg tablet |  | |
| levorphanol tartrate oral - | 2 mg tablet |  | |
| levorphanol tartrate oral - | 2 mg tablet |  | |
| levorphanol tartrate oral - | 3 mg tablet |  | |
| levorphanol tartrate oral - | 2 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
levorphanol tartrate oral
LEVORPHANOL - ORAL
(lee-VOR-fa-nole)
COMMON BRAND NAME(S): Levo-Dromoran
WARNING: Levorphanol has a risk for abuse and addiction, which can lead to overdose and death. Levorphanol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of levorphanol that works, and take 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 take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Be sure you know how to take levorphanol 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 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, take 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. Levorphanol is an opioid pain reliever. It acts on certain centers in the brain to give you pain relief.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking levorphanol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually every 6 to 8 hours as needed. If you have nausea, you may take this drug with food, although this may cause your body to absorb less of the drug and get less benefit from it. Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1-2 hours with as little head movement as possible).The dosage is based on your medical condition, age, and response to treatment. 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.Before you start using this medication, ask your doctor or pharmacist if you should stop or change how you use your other opioid medication(s). Other pain relievers (such as acetaminophen, ibuprofen) may also be prescribed. Ask your doctor or pharmacist about using levorphanol safely with other drugs.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). Take 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.Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, dry mouth, flushing, or vision problems 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.Tell your doctor right away if you have any serious side effects, including: interrupted breathing during sleep (sleep apnea), mental/mood changes (such as confusion, depression, abnormal thoughts), trouble urinating, fast/slow/irregular heartbeat, severe stomach/abdominal pain, 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: slow/shallow breathing, fainting, 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 taking levorphanol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, 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: brain disorders (such as seizures, head injury, tumor, increased intracranial pressure), heart problems (such as irregular heartbeat), low blood pressure, certain bowel diseases (such as paralytic ileus, toxic megacolon), breathing problems (such as asthma, chronic obstructive pulmonary disease-COPD, emphysema, low oxygen/high carbon dioxide in the blood, sleep apnea), disease of the pancreas (such as pancreatitis), mental/mood disorders (such as toxic psychosis), a certain spinal problem (kyphoscoliosis), gallbladder disease, personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), kidney disease, liver disease, adrenal gland problem (such as Addison's disease), difficulty urinating (such as due to enlarged prostate or urethral stricture), underactive thyroid (hypothyroidism).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).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.)Based on information from related drugs, this medication may pass 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: certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine), cimetidine, MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), naltrexone, samidorphan.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken 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.This medication may interfere with certain lab tests (such as amylase/lipase levels), possibly causing false test results. Make sure lab 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 breathing, slow heartbeat, weak muscles, extreme drowsiness, 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: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
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 June 2023. Copyright(c) 2023 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
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