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Levo-Dromoran Dosage

Generic name: levorphanol tartrate
Dosage form: injection, tablets

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The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Intravenous: The usual recommended starting dose for IV administration is up to 1 mg, given in divided doses, by slow injection. This may be repeated in 3 to 6 hours as needed, provided the patient is assessed for signs of hypoventilation or excessive sedation. Dosage should be adjusted according to the severity of the pain; age, weight and physical status of the patient; the patient’s underlying diseases; use of concomitant medications; and other factors (see INDIVIDUALIZATION OF DOSAGE, WARNINGS and PRECAUTIONS). Total daily doses of more than 4 to 8 mg IV in 24 hours are generally not recommended as starting doses in nonopioid tolerant patients; lower total daily doses may be appropriate.

Intramuscular or Subcutaneous: The usual recommended starting dose for IM or SC administration is 1 to 2 mg. This may be repeated in 6 to 8 hours as needed, provided the patient is assessed for signs of hypoventilation or excessive sedation. Dosage should be adjusted according to the severity of the pain; age, weight and physical status of the patient; the patient’s underlying diseases; use of concomitant medications; and other factors (see INDIVIDUALIZATION OF DOSAGE, WARNINGS and PRECAUTIONS). Total daily doses of more than 3 to 8 mg IM in 24 hours are generally not recommended as starting doses in nonopioid tolerant patients; lower total daily doses may be appropriate.

Oral: The usual recommended starting dose for oral administration is 2 mg. This may be repeated in 6 to 8 hours as needed, provided the patient is assessed for signs of hypoventilation and excessive sedation. If necessary, the dose may be increased to up to 3 mg every 6 to 8 hours, after adequate evaluation of the patient’s response. Higher doses may be appropriate in opioid tolerant patients. Dosage should be adjusted according to the severity of the pain; age, weight and physical status of the patient; the patient’s underlying diseases; use of concomitant medications; and other factors (see INDIVIDUALIZATION OF DOSAGE, WARNINGS and PRECAUTIONS). Total oral daily doses of more than 6 to 12 mg in 24 hours are generally not recommended as starting doses in nonopioid tolerant patients; lower total daily doses may be appropriate.

Use in Chronic Pain: The dosage of Levo-Dromoran in patients with cancer or with other conditions for which chronic opioid therapy is indicated must be individualized (see INDIVIDUALIZATION OF DOSAGE). Levo-Dromoran is 4 to 8 times as potent as morphine and has a longer half-life. Because there is incomplete cross-tolerance among opioids, when converting a patient from morphine to Levo-Dromoran, the total daily dose of oral Levo-Dromoran should begin at approximately 1/15 to 1/12 of the total daily dose of oral morphine that such patients had previously required and then the dose should be adjusted to the patient’s clinical response. If a patient is to be placed on fixed-schedule dosing (round-the-clock) with this drug, care should be taken to allow adequate time after each dose change (approximately 72 hours) for the patient to reach a new steady-state before a subsequent dose adjustment to avoid excessive sedation due to drug accumulation.

Use in The Perioperative Period: Levo-Dromoran has been used for analgesic action during premedication and the postoperative period. Factors to be considered in determining the dosage include age, body weight, physical status, underlying pathological condition, use of other drugs, type of anesthesia used, the surgical procedure involved and the severity of pain (see INDIVIDUALIZATION OF DOSAGE, WARNINGS and PRECAUTIONS).

Premedication: The preoperative medication dose of Levo-Dromoran should be individualized (see INDIVIDUALIZATION OF DOSAGE, WARNINGS and PRECAUTIONS). The usual dose for healthy young adults is 1 to 2 mg intramuscularly or subcutaneously, administered 60 to 90 minutes before surgery. Older or debilitated patients usually require less drug. Two mg of Levo-Dromoran is approximately equivalent to 10 to 15 mg of morphine or 100 mg of meperidine.

NOTE: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Pharmaceutical Incompatibilities of Levo-Dromoran: Levorphanol tartrate injection has been reported to be physically incompatible with solutions containing aminophylline, ammonium chloride, amobarbital sodium, chlorothiazide sodium, heparin sodium, methicillin sodium, nitrofurantoin sodium, novobiocin sodium, pentobarbital sodium, perphenazine, phenobarbital sodium, phenytoin sodium, secobarbital sodium, sodium bicarbonate, sodium iodide, sulfadiazine sodium, sulfisoxazole diethanolamine and thiopental sodium.

Safety and Handling: Levo-Dromoran is packaged in sealed systems that have a low risk of accidental exposure to health care workers. Ordinary care should be taken to avoid aerosol generation while preparing a syringe for use. Significant absorption from accidental dermal exposure is unlikely, and spilled Levo-Dromoran should be washed from the skin by rinsing with cool water. As with all controlled substances, abuse by health care personnel is possible and the drug should be handled accordingly.

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