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butorphanol

Pronunciation

Generic Name: butorphanol (nasal) (byoo TOR fa nole)
Brand Name: Stadol NS

What is butorphanol nasal?

Butorphanol is an opioid pain medication. An opioid is sometimes called a narcotic.

Butorphanol is used to treat moderate to severe pain.

Butorphanol may also be used for purposes not listed in this medication guide.

What is the most important information I should know about butorphanol nasal?

Butorphanol may be habit-forming, even at regular doses. Use this medicine exactly as prescribed by your doctor. Never share the medicine with another person. MISUSE OF NARCOTIC PAIN MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

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This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how butorphanol will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with butorphanol nasal.

What should I discuss with my healthcare provider before using butorphanol nasal?

You should not use this medicine if you are allergic to butorphanol.

To make sure this medicine is safe for you, tell your doctor if you have:

  • any type of breathing problem or lung disease;

  • liver or kidney disease;

  • a history of head injury, brain tumor, or seizures;

  • heart disease, high blood pressure, recent heart attack; or

  • a history of drug abuse, alcohol addiction, or mental illness.

Butorphanol nasal may be habit forming and should be used only by the person it was prescribed for. Never share butorphanol nasal with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away butorphanol is against the law.

FDA pregnancy category C. It is not known whether butorphanol nasal will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Butorphanol nasal can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the effects of this medication.

How should I use butorphanol nasal?

Follow all directions on your prescription label. Butorphanol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use butorphanol nasal in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Butorphanol may be habit-forming, even at regular doses. Use this medicine exactly as prescribed by your doctor. MISUSE OF NARCOTIC PAIN MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR DEATH.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

The usual dose of butorphanol nasal for pain is 1 spray into one nostril every 3 to 4 hours. Your dose may be different. Follow your doctor's instructions carefully.

For best results, blow your nose before using the nasal spray.

Before using the spray for the first time, you must prime the spray pump. Remove the protective clip and pump 7 or 8 times into the air until a fine mist appears. Prime the spray pump any time you have not used your nasal spray for longer than 48 hours.

Do not stop using butorphanol nasal suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using butorphanol nasal.

Store at room temperature away from moisture and heat.

After you are finished using this medication, remove the cap and rinse out the bottle under running water. Throw away the bottle and cap where children or pets cannot get to them.

What happens if I miss a dose?

Since butorphanol nasal is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A butorphanol overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.

What should I avoid while using butorphanol nasal?

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with butorphanol nasal.

This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how butorphanol will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Butorphanol nasal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • weak or shallow breathing, slow heart rate;

  • pounding or uneven heartbeats;

  • problems with urination;

  • tremors, numbness or tingling;

  • severe dizziness, confusion, feeling like you are floating;

  • a light-headed feeling, like you might pass out; or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Common side effects include:

  • drowsiness, dizziness;

  • sleep problems (insomnia);

  • nausea, vomiting; or

  • stuffy nose.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Butorphanol Dosing Information

Usual Adult Dose for Anesthesia:

The preoperative dosage of butorphanol should be individualized. However, the following guidelines may be helpful.

Preoperative Medication:
Initial dose: 2 mg intramuscularly 60 to 90 minutes before surgery

Balanced Anesthesia:
Initial dose: 2 mg intravenously shortly before induction and/or 0.5 mg to 1 mg in increments during anesthesia. The increments may be higher, up to 0.06 mg/kg (4 mg/70 kg) depending on the previous sedative, analgesic, and hypnotic drugs administered.

The total dose needed will vary. However, patients have generally been reported to have needed between a total dosage of 4 mg to 12.5 mg (approximately 0.06 to 0.18 mg/kg).

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.

Usual Adult Dose for Labor Pain:

For use In the treatment of patients at full term early in labor:
Initial dose: 1 or 2 mg intravenously or intramuscularly once.

This dose may be repeated in 4 hours if necessary.

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.

Usual Adult Dose for Pain:

Initial dose: 1 mg intravenously once. Depending on the severity of the pain, effective intravenous doses range from 0.5 to 2 mg.

An initial dose of 2 mg of butorphanol intramuscularly once may be appropriate for patients who will be able to remain recumbent if drowsiness or dizziness occurs. Depending on the severity of the pain, effective intramuscular doses range from 1 to 4 mg.

Alternatively, an initial dose of 1 mg of butorphanol by nasal administration (1 spray in one nostril) once. Adherence to this dose has been reported to have led to a reduced incidence of drowsiness and dizziness. If adequate pain relief is not achieved within 60 to 90 minutes, an additional 1 mg dose may be administered. Depending on the severity of the pain, an initial dose of 2 mg (1 spray in each nostril) may be appropriate in patients who will be able to remain recumbent if drowsiness or dizziness occurs.

Initial doses may be repeated after 3 to 4 hours if necessary. (This includes the initial dosage sequence of 1 mg by nasal administration followed by a second 1 mg dose in 60 to 90 minutes if necessary. This sequence may be repeated 3 to 4 hours after the second dose if necessary.)

Subsequent doses may be determined by patient response, rather than being scheduled at fixed dosing intervals.

What other drugs will affect butorphanol nasal?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before using butorphanol nasal with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with butorphanol nasal, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about butorphanol nasal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.03. Revision Date: 2014-01-13, 5:21:09 PM.

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