Generic Name: butorphanol (injection) (byoo TOR fa nole)
Brand Name: Stadol
What is butorphanol?
Butorphanol is an opioid pain medication. An opioid is sometimes called a narcotic.
Butorphanol is used to treat moderate to severe pain. It is also used as part of anesthesia for surgery, or during early labor (if childbirth is expected to be more than 4 hours away).
Butorphanol may also be used for purposes not listed in this medication guide.
What is the most important information I should know about butorphanol?
You should not use butorphanol if you have recently used narcotic medications and have become dependent on them.
Butorphanol can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Butorphanol may also be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medicine in a place where others cannot get to it.
MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.
What should I discuss with my healthcare provider before using butorphanol?
You should not use butorphanol if you are allergic to it, or if you have recently used narcotic medications and have become dependent on them.
Some medicines can interact with butorphanol and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.
To make sure butorphanol 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.
It is not known whether butorphanol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using butorphanol.
Butorphanol is sometimes used during early labor, but using it just before childbirth can cause breathing problems in a newborn.
Butorphanol 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 side effects of this medication.
How should I use butorphanol?
Butorphanol is injected into a muscle or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.
Follow all directions on your prescription label. Butorphanol can slow or stop your breathing. Never use butorphanol 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. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away butorphanol is against the law.
Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.
Do not stop using butorphanol suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using butorphanol.
Store butorphanol at room temperature away from moisture and heat.
What happens if I miss a dose?
Since butorphanol 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?
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with butorphanol.
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 side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
weak or shallow breathing;
pounding, or uneven heartbeats;
problems with urination;
confusion, feeling like you are floating;
a light-headed feeling, like you might pass out; or
dangerously high blood pressure (severe headache, blurred vision, ringing in your ears, anxiety, confusion, chest pain, trouble breathing, seizure).
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Common side effects include:
constipation, nausea, vomiting;
dry mouth; or
warmth or redness under the skin.
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.
Initial dose: 2 mg intramuscularly 60 to 90 minutes before surgery
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?
Some medicines can cause unwanted or dangerous effects when used with butorphanol. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.
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 taking butorphanol with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Other drugs may interact with butorphanol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
More about butorphanol
- Butorphanol solution
- Butorphanol nasal
- Butorphanol Injection (Advanced Reading)
- Butorphanol Nasal (Advanced Reading)
- Other brands: Stadol
Related treatment guides
Where can I get more information?
- Your pharmacist can provide more information about butorphanol injection.
- 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.
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