butorphanol (Stadol)

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GENERIC NAME: butorphanol


DRUG CLASS AND MECHANISM: Butorphanol is a synthetic opioid narcotic pain reliever. It prevents pain in a similar way as morphine (MS Contin), hydrocodone (Zohydro), oxycodone (Oxycontin), and other opioids. Like other opioids, it stimulates receptors in the brain to increase the threshold to pain (the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain). The FDA approved butorphanol in August 1978.



PREPARATIONS: Solution with or without preservatives: 1 or 2 mg/mL in 1, 2, 10 mL; Nasal solution: 10 mg/ mL in 2.5 mL bottle.

STORAGE: Butorphanol solution should be stored at room temperature, between 15 C to 30 C (59 F to 86 F) and protected from light. Nasal spray should be stored at room temperature between 20 C to 25 C (68 F to 77 F).

PRESCRIBED FOR: Butorphanol is prescribed for the treatment of pain that is severe enough to require an opioid, as well as for preoperative or preanesthetic pain management. It is also used to supplement balanced anesthesia and manage pain during labor.

DOSING: The initial dose for adults is based on the setting in which it is used, as well as whether it is delivered intramuscularly, intravenously, or through nasal spray. Most initial intravenous doses for pain range between 0.5 to 2 mg, which may be repeated every 3 to 4 hours as needed.

DRUG INTERACTIONS: Combining butorphanol with other agents that cause depression of the central nervous system may lead to increased sedation and confusion.

Alvimopan (Entereg) should not be combined with butorphanol because it increases levels of butorphanol.

Butorphanol should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Butorphanol should not be administered within 14 days of stopping an MAOI.

PREGNANCY: Butorphanol is a Category C drug and is approved for pain management during pregnancy. It crosses the placenta and may affect the newborn's heart beat and breathing, so low doses and careful monitoring is recommended. Chronic exposure may lead to withdrawal symptoms.

NURSING MOTHERS: Butorphanol is excreted in breast milk. The amount that the infant may receive is very low and insignificant.

SIDE EFFECTS: The most frequent adverse reactions include drowsiness, dizziness, nausea, vomiting, and nasal congestion and insomnia with the nasal preparation. Patients may also experience palpitations, flushing, anxiety, confusion, euphoria, headache, nervousness, tingling sensation in limbs, cold/clammy skin, sweating, itchiness, anorexia, constipation, stomach pain, dry mouth, tremor, weakness, blurred vision, ringing in ears, and difficulty breathing. Butorphanol is habit forming. Mental and physical dependence can occur when used long-term.


FDA Prescribing Information.

Medscape. butorphanol (Rx) - Stadol.

Medically Reviewed by a Doctor on 8/12/2014

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