Trade Names:Levo-Dromoran- Tablets 2 mg- Injection 2 mg/mL
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 t ½ is about 11 to 16 h; Cl is 0.78 to 1.1 L/kg/h.
Following IM administration, onset of effects appear to be within 15 to 30 min.
Management of moderate to severe pain or as a preoperative medication when opioid analgesia is appropriate.
IV Recommended starting dose is up to 1 mg given in divided doses, by slow injection. This may be repeated in 3 to 6 h as needed. Generally, total daily doses of more than 4 to 8 mg IV in 24 h are not recommended. IM/Subcutaneous Recommended starting dose is 1 to 2 mg. This may be repeated in 6 to 8 h as needed. Generally, total daily doses of more than 3 to 8 mg in 24 h are not recommended. 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 doses of more than 6 to 12 mg in 24 h are not recommended.Chronic PainAdults
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 UseAdults
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.PremedicationAdults
IM/Subcutaneous Usual dose is 1 to 2 mg given 60 to 90 min before surgery. Elderly or debilitated patients usually require less drug.Respiratory Function ImpairmentAdults
Reduce dose by 50% or more.
Store injection and tablets at controlled room temperature (59° to 86°F).
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.Incompatibilities
Do not mix with aminophylline, ammonium chloride, amobarbital, chlorothiazide, diethanolamine, heparin, methicillin, nitrofurantoin, novobiocin, pentobarbital, perphenazine, phenobarbital, phenytoin, secobarbital, sodium bicarbonate, sodium iodide, sulfadiazine, sulfisoxazole, or thiopental.
None well documented.
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.
Injection site reaction; 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%.
Use with caution and reduce initial dose in patients who are elderly or debilitated, or those who have severe hepatic or renal function 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 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.
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