Butorphanol

Butorphanol is a prescription medication used for alleviating labor pain or other pain and as preoperative and balanced anesthesia.

• Butorphanol is available under the following different brand names: Stadol

Adult dosage

Injectable solution: Schedule IV

• 1mg/mL
• 2mg/mL

Nasal spray: Schedule IV

• 10 mg/mL (1mg/spray) 

Pain 

Adult dosage

• IV: 1 mg IV every 3-4 hours or as needed; dosage range 0.5-2 mg every 3-4 hours
• IM: 2 mg IM every 3-4 hours; dosage range 1-4 mg every 3-4 hours

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 giving an initial dose of 2 mg (1 spray in each nostril); the patient must remain recumbent; do not repeat this dose
• Maintenance: 1 mg (1 spray in 1 nostril) every 3-4 hours or as needed

Balanced Anesthesia

Adult dosage

• 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

Adult dosage

• 1-2 mg/dose IV/IM; may repeat as needed every 4 hours

Preoperative & Pre anesthesia

Adult dosage

• 2 mg IM 60-90 minutes preop

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Butorphanol include:

• nausea,
• vomiting,
• drowsiness,
• dizziness,
• dry mouth, and
• warmth or redness under the skin 

Serious side effects of Butorphanol include:

• noisy breathing,
• sighing,
• shallow breathing,
• breathing that stops during sleep,
• slow heart rate,
• weak pulse,
• fast or pounding heartbeats,
• problems with urination,
• lightheadedness,
• confusion,
• a feeling of floating,
• agitation,
• hallucinations,
• fever,
• sweating,
• shivering,
• muscle stiffness,
• twitching,
• loss of coordination,
• nausea,
• vomiting, and
• diarrhea 

Rare side effects of Butorphanol include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Butorphanol has severe interactions with the following drug:
  • alvimopan 
• Butorphanol has serious interactions with at least 50 other drugs:
• Butorphanol has moderate interactions with at least 189 drugs.
• Butorphanol has minor interactions with the following drugs:
  • brimonidine
  • dextroamphetamine
  • eucalyptus
  • lidocaine
  • sage
  • ziconotide

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Absolute: opioid dependence, respiratory depression, respiratory failure
• Relative: cardiac arrhythmias, cardiovascular disease, coronary insufficiency, myocardial infarction, toxin-mediated diarrhea 

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Butorphanol?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Butorphanol?”

Cautions

• Drug abuse, emotional lability, head injury, hepatic/renal impairment, increased ICP, GI/urinary obstruction, BPH, hypothyroidism
• Less risk of respiratory sedation than with pure opioid agonist
• May produce withdrawal in opioid-dependent patients
• Avoid alcohol

Pregnancy and Lactation

• Use with caution if the benefits outweigh risks during pregnancy; use in life-threatening emergencies when no safer drugs are available 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)