butorphanol

Generic Name: butorphanol (nasal) (byoo TOR fa nole)Brand names: Stadol NS, Stadol

What is butorphanol nasal?

Butorphanol is in a group of drugs called narcotic pain relievers. It is similar to morphine.

Butorphanol is used to treat moderate to severe pain.

Butorphanol may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about butorphanol nasal?

You should not use butorphanol if you have recently used narcotic medications and have become dependent on them. Butorphanol may be habit-forming and should be used only by the person it was prescribed for. Butorphanol should never be given to another person, especially someone with a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Do not drink alcohol while you are using butorphanol. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine. Check your food and medicine labels to be sure these products do not contain alcohol. Butorphanol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Never use more than your prescribed dose of butorphanol. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Do not stop using butorphanol suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

What should I discuss with my healthcare provider before using butorphanol nasal?Do not use this medication if you have ever had an allergic reaction to a narcotic medicine.

You should not use butorphanol if you have recently used narcotic medications and have become dependent on them.

Butorphanol may be habit-forming and should be used only by the person it was prescribed for. Butorphanol should never be shared with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Before using this medication, tell your doctor if you have

• asthma, COPD, sleep apnea, or other breathing disorders;

• liver or kidney disease;

• a history of head injury or brain tumor;

• heart disease, high blood pressure, recent heart attack;

• mental illness; or

• a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use butorphanol or you may require a dose adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Butorphanol passes into breast milk and may harm a nursing baby. Do not use butorphanol without telling your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the effects of this medication.

How should I use butorphanol nasal?

Use this medication exactly as it was prescribed for you. Never use butorphanol in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

The usual dose of butorphanol nasal for pain is 1 spray into one nostril every 3 to 4 hours. Your dose may be different. Follow your doctor's instructions carefully.

For best results, blow your nose before using the nasal spray.

Before using the spray for the first time, you must prime the spray pump. Remove the protective clip and pump 7 or 8 times into the air until a fine mist appears. Prime the spray pump any time you have not used your nasal spray for longer than 48 hours.

Do not stop using butorphanol suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

Store butorphanol at room temperature away from moisture and heat.

After you are finished using this medication, remove the cap and rinse out the bottle under running water. Throw away the bottle and cap where children or pets cannot get to them.

What happens if I miss a dose?

Since butorphanol is used as needed, you are not likely to be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of butorphanol can be fatal. Overdose symptoms may include extreme drowsiness, pinpoint pupils, confusion, cold and clammy skin, weak pulse, shallow breathing, fainting, or breathing that stops.

What should I avoid while using butorphanol nasal?

Do not drink alcohol while you are using this medication. Dangerous side effects or death can occur when alcohol is combined with butorphanol. Check your food and medicine labels to be sure these products do not contain alcohol. This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

If your prescribed dose is more than 1 spray at a time, you may have severe dizziness. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Butorphanol nasal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have any of these serious side effects:

• pounding, or uneven heartbeats;

• increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure);

• shallow breathing, slow heartbeat;

• cold, clammy skin;

• problems with urination;

• tremors, numbness or tingling;

• confusion, feeling like you are floating; or

• feeling light-headed, fainting.

Less serious side effects include:

• drowsiness, dizziness;

• nosebleed, stuffy nose, cough;

• sleep problems (insomnia);

• constipation;

• nausea, vomiting, loss of appetite;

• warmth or redness under the skin;

• dry mouth, unpleasant taste; or

• ringing in your ear.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Butorphanol Dosing Information

Usual Adult Dose for Anesthesia:

The preoperative dosage of butorphanol should be individualized. However, the following guidelines may be helpful.Preoperative Medication:Initial dose: 2 mg intramuscularly 60 to 90 minutes before surgeryBalanced Anesthesia: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 nasal?

You should not use butorphanol with other narcotic pain medications, sedatives, tranquilizers, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result. Tell your doctor if you need to use any of these other medicines while you are using butorphanol.

There may be other drugs that can interact with butorphanol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist has additional information about butorphanol written for health professionals that you may read.

• 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
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 2.03. Revision Date: 4/12/2009 4:38:25 PM.