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Pronunciation: lee-VORE-fah-nole TAR-trate
Class: Opioid analgesic
- Tablets, oral 2 mg
Acts at receptors in the gray matter in the brain and spinal cord to alter the transmission and perception of pain.
Steady-state plasma levels are reached by the third day of dosing. Well absorbed following oral administration, reaching the C max in about 1 h.
Vd is 10 to 13 L/kg. Plasma protein binding is 40%.
Terminal half-life is about 11 to 16 h; Cl is 0.78 to 1.1 L/kg/h.
Indications and Usage
Management of moderate to severe pain, or as a preoperative medication when opioid analgesia is appropriate.
None well documented.
Dosage and AdministrationAdults
PO Recommended starting dose is 2 mg. This may be repeated in 6 to 8 h as needed. If necessary, the dose may be increased to 3 mg every 6 to 8 h. Generally, total oral daily dosages of more than 6 to 12 mg in 24 h are not recommended.Chronic Pain
PO When converting a patient from morphine to levorphanol, begin the total daily dose of levorphanol at approximately 1/15 to 1/12 the total daily dose of oral morphine.Perioperative Use
Dosage should be based on age, body weight, physical status, underlying pathological condition, other drug usage, type of anesthesia, surgical procedure, and severity of pain.Respiratory Function Impairment
Reduce dose by 50% or more.
- Administer prescribed dose without regard to meals. Administer with food if GI upset occurs.
- If using fixed-scheduled dosing (round the clock), do not escalate dose more often than every 72 h to allow patient to reach new steady-state and reduce risk of excessive sedation caused by drug accumulation.
Store between 59° and 86°F.
Drug InteractionsAgonist/Antagonist opioid analgesics (eg, buprenorphine, butorphanol, nalbuphine, pentazocine)
Do not administer to patients receiving levorphanol.CNS depressants (eg, alcohol, antihistamines, barbiturates, general anesthetics, hypnotics, other opioids, phenothiazines, sedatives, skeletal muscle relaxants, tranquilizers, tricyclic antidepressants)
Additive CNS depressant effects. Respiratory depression, hypotension, profound sedation, or coma may occur.
Arrhythmias (including bradycardia and tachycardia), cardiac arrest, extrasystoles, hypotension, palpitations, shock.
Abnormal dreams, abnormal thinking, amnesia, coma, confusion, convulsions, depression, dizziness, drug withdrawal, dyskinesia, hyperkinesia, hypokinesia, insomnia, lethargy, nervousness, personality disorder, stimulation, suicide attempt.
Pruritus, rash, sweating, urticaria.
Abnormal vision, diplopia, pupillary disorder.
Abdominal pain, biliary tract spasm, dry mouth, dyspepsia, nausea, vomiting.
Difficulty urinating, kidney failure, urinary retention.
Apnea, cyanosis, hypoventilation.
Category C .
Safety and efficacy not established.
Reduce initial dose 50%.
Special Risk Patients
Use with caution and reduce initial dose in patients who are elderly or debilitated, or those who have severe hepatic or renal impairment, hypothyroidism, Addison disease, toxic psychosis, prostatic hypertrophy, urethral stricture, acute alcoholism, or delirium tremens.
Use in acute or severe bronchial asthma is not recommended.
May increase pressure in common bile duct when given in analgesic doses; use is not recommended in biliary surgery.
Because the effects on heart activity are unknown, limit levorphanol use in patients with myocardial dysfunction, acute MI, or coronary insufficiency.
Has abuse potential.
Respiratory depressant effects may be markedly exaggerated in the presence of head injury, intracranial lesions, or preexisting increased intracranial pressure.
May cause severe hypotension in postoperative patients or in individuals whose ability to maintain BP is compromised (eg, volume depletion). May cause orthostatic hypotension in ambulatory patients.
Use with caution in patients with extensive liver disease.
May cause serious or potentially fatal respiratory depression if given in excessive dose, too frequently, or if given in full dosage to compromised patients. Use with caution in patients with impaired respiratory reserve or respiratory depression. Reduce initial dose by 50% or more.
Discontinuation after chronic use has been reported to result in withdrawal syndrome.
Apnea, bradycardia, cardiac arrest, circulatory collapse, CNS depression, cold and clammy skin, constricted pupils, CV failure, extreme somnolence progressing to stupor or coma, hypotension, respiratory depression, skeletal muscle flaccidity, death.
- Caution patients or caregivers that medication may be habit forming, to take as prescribed, and not to stop taking or change the dose unless advised by their health care provider. Advise patients or caregivers to notify their health care provider if medication does not adequately control pain.
- Advise patient, family, or caregiver that if medication needs to be discontinued after prolonged use, it will usually be slowly withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal.
- Advise patients to notify their health care provider if any of the following occur and are bothersome or appear to worsen: dizziness or lightheadedness; sleepiness or drowsiness; upset stomach, vomiting, constipation, or stomach pain; rash; difficulty urinating.
- Advise patients or caregivers to immediately notify their health care provider if any of the following occur: fainting, slow or shallow breathing, excessive sleepiness.
- Instruct patients to get up slowly from lying or sitting position and to avoid sudden position changes to prevent postural hypotension. Advise patients to report dizziness with position changes to their health care provider. Caution patients that hot tubs and hot showers or baths may make dizziness worse.
- Caution patient that drug may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined.
- Caution patient to avoid alcohol and other CNS depressant medications while using this medication.
- Advise patient that medication is usually started at a low dose and then gradually increased as tolerated until maximum benefit is obtained.
- Advise patient that if a dose is missed, to take it as soon as possible unless it is nearing time for the next scheduled dose. If it is nearing time for the next dose, advise patient to skip the missed dose and take the next dose at the regularly scheduled time. Caution patient not to double the dose to catch up.
Copyright © 2009 Wolters Kluwer Health.