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Levorphanol

Generic Name: levorphanol (oral) (lee VOR fa nole)
Brand Name: Levo-Dromoran

Medically reviewed on December 12, 2017.

What is levorphanol?

Levorphanol is an opioid pain medication, sometimes called a narcotic.

Levorphanol is used to treat moderate to severe pain.

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

Important Information

Levorphanol can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

Taking this medicine during pregnancy may cause life-threatening withdrawal symptoms in the newborn.

Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

Before taking this medicine

You should not use levorphanol if you are allergic to it.

To make sure levorphanol is safe for you, tell your doctor if you have ever had:

  • any type of breathing problem or lung disease;

  • heart disease;

  • stomach problems;

  • liver disease;

  • a head injury, brain tumor, or seizures;

  • drug or alcohol addiction, mental illness;

  • urination problems; or

  • problems with your gallbladder, adrenal gland, or thyroid.

If you use levorphanol while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

Do not breast-feed while taking levorphanol. Levorphanol may cause serious side effects in the nursing baby.

Levorphanol is not approved for use by anyone younger than 18 years old.

How should I take levorphanol?

Follow all directions on your prescription label. Levorphanol can slow or stop your breathing. Never use levorphanol in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Your dose needs may be different if you are already being treated with a similar opioid medicine and your body is tolerant to it.

Levorphanol may be habit-forming. 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 levorphanol is against the law.

Do not stop using levorphanol suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using levorphanol.

Store at room temperature away from moisture and heat. Keep track of your medicine. Levorphanol is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Do not keep leftover opioid medication. Just one dose can cause death in someone using this medicine accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, flush the unused medicine down the toilet.

Never crush or break a levorphanol pill to inhale the powder or mix it into a liquid to inject the drug into your vein. Doing so could result in death.

What happens if I miss a dose?

Since levorphanol 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 take 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 levorphanol 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, or coma.

What should I avoid while taking levorphanol?

Do not drink alcohol. Dangerous side effects or death could occur.

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

Levorphanol side effects

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

Like other narcotic medicines, levorphanol can slow your breathing. Death may occur if breathing becomes too weak.

A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Stop using levorphanol and call your doctor at once if you have:

  • slow heart rate, weak pulse, weak or shallow breathing, blue lips or fingernails;

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

  • mood changes, confusion, unusual thoughts or behavior;

  • seizure (convulsions);

  • pounding heartbeats or fluttering in your chest;

  • severe stomach pain; or

  • severe constipation, painful or difficult urination.

Serious side effects may be more likely in older adults and those who are overweight, malnourished, or debilitated.

Long-term use of opioid medication may affect fertility (ability to have children) in men or women. It is not known whether opioid effects on fertility are permanent.

Common side effects may include:

  • dizziness, drowsiness, blurred vision, memory problems;

  • nausea, vomiting, dry mouth;

  • constipation;

  • itching, sweating;

  • flushing (warmth, redness, or tingly feeling); or

  • sleep problems (insomnia).

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)

Levorphanol dosing information

Usual Adult Dose for Pain:

As First Opioid Analgesic:
Initial dose: 1 to 2 mg orally every 6 to 8 hours as needed for pain
-May increase dose up to 3 mg orally every 6 to 8 hours as needed; if around the clock dosing is used, allow 72 hours for patient to reach a new steady-state before dose adjustment
Maximum doses: Higher doses may be appropriate in opioid tolerant patients

CONVERSION from other Opioids:
-Due to inter-patient variability, a conservative approach is advised
-Levorphanol is 4 to 8 times as potent as morphine and has a longer half-life
-May consider initiating levorphanol at 1/15 to 1/12 the total daily dose of oral morphine and adjust to clinical response
-Allow 72 hours for patient to reach a new steady-state before dose adjustment

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

What other drugs will affect levorphanol?

Narcotic (opioid) medication can interact with many other drugs and cause dangerous side effects or death. Be sure your doctor knows if you also use:

This list is not complete. Other drugs may interact with levorphanol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Further information

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.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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