Generic Name: Butorphanol Brand Name(s): Generics only. No brands available. Avability: Rx Pregnancy Category: C

Uses

What is Butorphanol used for?

Butorphanol is used to treat moderate to severe pain, including pain from surgery, muscle pain, and migraine headaches. Butorphanol is an opioid (narcotic) 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.

How should I take Butorphanol?

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 (e.g., 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).

This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as restlessness, runny nose, watering eyes, trouble sleeping, severe abdominal/muscle pain, nausea, vomiting, rapid breathing, and fast heartbeat) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions right away.

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.

Inform your doctor if your pain persists or worsens.

How do I store Butorphanol?

Butorphanol is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Butorphanol in the bathroom or the freezer. There may be different brands of Butorphanol that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Butorphanol down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Butorphanol?

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 (e.g., 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).

This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as restlessness, runny nose, watering eyes, trouble sleeping, severe abdominal/muscle pain, nausea, vomiting, rapid breathing, and fast heartbeat) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions right away.

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.

Inform your doctor if your pain persists or worsens.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Butorphanol during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Butorphanol. Butorphanol is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Butorphanol?

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 persist or worsen, tell your doctor or pharmacist promptly.

To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help with selecting a laxative (e.g., stimulant-type with stool softener).

Remember that your doctor has prescribed this medication because he or she 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, mental/mood changes (e.g., 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.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Butorphanol?

Some products that may interact with this drug include: MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), naltrexone, nasal decongestants (e.g., oxymetazoline).

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, 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), HIV medications (such as ritonavir), rifamycins (such as rifabutin, rifampin), 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.

Butorphanol may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Butorphanol?

Butorphanol may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Butorphanol?

Butorphanol may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Butorphanol.

What is the dose of Butorphanol for an adult?

Usual Adult Dose for Anesthesia

Preoperative Medication:

Initial dose: 2 mg IM 60 to 90 minutes before surgery

Balanced Anesthesia:

Initial dose: 2 mg IV shortly before induction and/or 0.5 mg to 1 mg IV in increments during anesthesia

Minimum doses: Total dose is seldom less than 4 mg (0.06 mg/kg)

Maximum doses: Total dose is seldom more than 12.5 mg (0.18 mg/kg)

Comments:

-The above doses are provided as guidance, doses should be individualized; age, body weight, physical status, underlying pathological condition, use of other drugs, type of anesthesia, and surgical procedure should be considered when determining dose.

-Because butorphanol nasal spray has not been studied for use in induction or maintenance anesthesia, use of the nasal spray for anesthesia is not recommended.

Uses: As a preoperative or pre-anesthetic medication; as a supplement to balanced anesthesia.

Usual Adult Dose for Labor Pain

Full term early labor:

Initial dose: 1 or 2 mg IV or IM; may repeat dose in 4 hours if necessary

Comments:

-Alternative analgesia should be used for pain associated with delivery or if delivery is expected to occur within 4 hours.

-Because butorphanol nasal spray has not been studied for use in labor, use of the nasal spray for labor is not recommended.

Use: For the relief of pain during early labor.

Usual Adult Dose for Pain

Parenteral (IM or IV):

-Initial dose: 1 mg IV every 3 to 4 hours; effective dose range: 0.5 to 2 mg every 3 to 4 hours

-Initial dose: 2 mg IM every 3 to 4 hours; effective dose range: 1 to 4 mg every 3 to 4 hours

Maximum IM dose: 4 mg

Nasal Spray:

-Initial dose sequence: 1 mg (1 spray) into 1 nostril; an additional 1 mg may be given in 60 to 90 minutes if adequate pain relief is not achieved, then every 3 to 4 hours (after the second dose of the sequence) as needed

-SEVERE PAIN: 2 mg intranasally (1 spray in each nostril); additional doses may be give every 3 to 4 hours as needed

Comments:

-Doses should be adjusted according to the severity of the pain, age, weight, physical status, and use of concomitant medications.

-For patients receiving the nasal spray, the incidence of adverse events is higher with the initial 2-mg dose; these patients should be recumbent with the first dose in the event drowsiness or dizziness occurs.

-Monitor closely for respiratory depression especially on initiation and with each dose increase.

-Because of the risks of addiction, abuse, and misuse, even at recommended doses, this drug should be reserved for use in patients for whom alternative treatment options have not or are not expected to be tolerated or have not or are not expected to provide adequate analgesia.

Use: For the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Renal Dose Adjustments

Parenteral:

-Initial dose should be limited to 1 mg (e.g. 0.5 mg IV and 1 mg IM), may repeat dose in 90 to 120 minutes as needed; repeat doses should be determined by response, but generally no more frequently than every 6 hours

Nasal spray:

-Initial dose should be limited to 1 mg; if additional pain relief is needed, a second 1 mg dose may be given in 90 to 120 minutes; repeat doses should be determined by response, but generally no more frequently than every 6 hours

Liver Dose Adjustments

Parenteral:

-Initial dose should be limited to 1 mg (e.g. 0.5 mg IV and 1 mg IM), may repeat dose in 90 to 120 minutes as needed; repeat doses should be determined by response, but generally no more frequently than every 6 hours

Nasal spray:

-Initial dose should be limited to 1 mg; if additional pain relief is needed, a second 1 mg dose may be given in 90 to 120 minutes; repeat doses should be determined by response, but generally no more frequently than every 6 hours

Dose Adjustments

Elderly:

-Parenteral: Initial dose should be limited to 1 mg (e.g. 0.5 mg IV and 1 mg IM), may repeat dose in 90 to 120 minutes as needed; repeat doses should be determined by response, but generally no more frequently than every 6 hours

-Nasal spray: Initial dose should be limited to 1 mg; if additional pain relief is needed, a second 1 mg dose may be given in 90 to 120 minutes; repeat doses should be determined by response, but generally no more frequently than every 6 hours

CYP450 3A4 Interactions:

-Consult drug interactions for patients receiving any CYP450 3A4 inhibitor or inducer

Discontinuation in Physically Dependent Patients:

-Taper dose gradually by 25% to 50% every 2 to 4 days

-If signs and symptoms of withdrawal appear, may raise the dose to the previous level and taper more slowly (either by increasing the interval between doses, decreasing the dose, or both)

-Do not abruptly discontinue in the physically-dependent patient

What is the dose of Butorphanol for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Butorphanol available?

Butorphanol is available in the following dosage forms and strengths:

  • Nasal spray,
  • Injectable solution.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Butorphanol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 29, 2018 | Last Modified: August 29, 2018

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