Butorphanol

Butorphanol is a pain relieving medicine used to treat moderate to severe pain. It is usually administered as a pre-anesthetic medicine before a surgical procedure, and for relief of pain during labor. It is usually given in conditions where other alternative treatments are inadequate. Butorphanol is generally administered by a healthcare professional. You should not self-administer this medicine at home. The dose will depend on what you are taking it for and how well it helps your symptoms. The most common side effects of this medicine include injection site reactions (such as pain, redness, and swelling), headache, dizziness, sleepiness, vomiting, nausea, and constipation. If any of these side effects persist or get worse, you should let your doctor know. Your doctor may be able to suggest ways of preventing or reducing the symptoms. Before using it, you should let your doctor know if you have a history of stomach ulcers, heart diseases, high blood pressure, and liver or kidney disease. Let your doctor also know about all the other medicines you are taking because they may affect, or be affected by, this medicine. Pregnant and breastfeeding women should consult their doctors before using the medicine. Butorphanol is an opioid analgesic (pain reliever). It works by blocking transmission of pain signals to the brain to lower pain perception.

• Moderate to severe pain

Butorphanol is a phenanthrene derivative with opioid agonist and antagonist properties. It has central analgesic actions and produces generalised CNS depression. It also alters perception of and response to pain by binding to opiate receptors in the CNS.

Adult Dose: Pain Parenteral Indicated for pain when use of opioid analgesic is appropriate IV: 1 mg IV q3-4hr PRN; dosage range 0.5-2 mg q3-4hr IM: 2 mg IM q3-4 hr; dosage range 1-4 mg q3-4hr Intranasal Initial: 1 mg (1 spray in 1 nostril); may repeat once after 60-90 min if inadequate pain relief Depending on pain severity, by give initial dose of 2 mg (1 spray in each nostril); patient must remain recumbant; do not repeat this dose Maintenance: 1 mg (1 spray in 1 nostril) q3-4hr prn Balanced Anesthesia Parenteral 2 mg IV before induction and/or 0.5-1 mg increments during anesthesia (higher dose may be required, up to 0.06 mg/kg, or 4 mg/70 kg) Total cumulative dose varies; typically ranges between 4-12.5 mg (0.06-0.18 mg/kg) Labor Pain Indicated for labor pain in full-term (37 weeks gestation or more) women without fetal distress in early labor 1-2 mg/dose IV/IM; may repeat PRN q4hr Decrease dose if concomitantly used with other analgesics or CNS depressants Do not administer within 4 hr of anticipated delivery Preoperative & Preanesthesia 2 mg IM 60-90 minutes preop This dose is approximately equipotent to morphine 10 mg or meperidine 80 mg Elderly Parenteral Decrease initial dose by 50% (0.5 mg IV and 1 mg IM) Increase dose interval from q4hr to q6hr Intranasal 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn Hepatic Impairment Parenteral Decrease initial dose by 50% (0.5 mg IV and 1 mg IM) Increase dose interval from q4hr to q6hr Intranasal 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn Child Dose: <18 years old: Not recommended Renal Dose: Renal Impairment Parenteral Decrease initial dose by 50% (0.5 mg IV and 1 mg IM) Increase dose interval from q4hr to q6hr Intranasal 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn

Your doctor or nurse will give you this medicine. Kindly do not self administer.

If you miss a dose of Butorphanol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common: • Headache • Dizziness • Sleepiness • Vomiting • Nausea • Constipation • Injection site reactions (pain, swelling, redness)

[UNSAFE] Butorphanol may cause side effects which could affect your ability to drive. Opioid analgesics, including Butorphanol, impair the mental and physical abilities required for the performance of potentially dangerous tasks such as driving a car. Use Butorphanol as instructed by your doctor. Never take in greater amounts or more often than prescribed. It causes sleepiness or drowsiness. If this happens to you, do not drive or use machinery. Avoid consuming alcohol when taking the Butorphanol, as it may cause excessive sleepiness or drowsiness. Inform your doctor if you have ever been diagnosed with kidney or liver problems. Store opioid pain relievers in a safe place and out of reach of others.

Opiate-dependent patients who have not been detoxified; acute resp depression; pregnancy.

Additive depressant effects with other CNS depressants e.g. general anaesthetics, phenothiazines or other tranquilizers, sedatives, hypnotics, antihistamines or alcohols.

[UNSAFE] Butorphanol may cause excessive drowsiness with alcohol.

[CONSULT YOUR DOCTOR] Butorphanol may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.

[SAFE IF PRESCRIBED] Butorphanol is safe to use during breastfeeding. Human studies suggest that the drug does not pass into the breastmilk in a significant amount and is not harmful to the baby. Baby should be monitored for excessive sleepiness and weight gain.

[CAUTION] Butorphanol should be used with caution in patients with kidney disease. Dose adjustment of Butorphanol may be needed. Please consult your doctor. [CAUTION] Butorphanol should be used with caution in patients with liver disease. Dose adjustment of Butorphanol may be needed. Please consult your doctor.