butorphanol tartrate

Action

Alters perception of and emotional response to pain by binding with opioid receptors in brain, causing CNS depression. Also exerts antagonistic activity at opioid receptors, which reduces risk of toxicity, drug dependence, and respiratory depression.

Availability

Injection: 1 mg/ml, 2 mg/ml

Nasal spray: 10 mg/ml

Indications and dosages

➣ Moderate to severe pain

Adults: 1 to 4 mg I.M. q 3 to 4 hours as needed, not to exceed 4 mg/dose. Or 0.5 to 2 mg I.V. q 3 to 4 hours as needed. With nasal spray, 1 mg (one spray in one nostril) q 3 to 4 hours, repeated in 60 to 90 minutes if needed.

➣ Labor pains

Adults: 1 to 2 mg I.V. or I.M., repeated after 4 hours as needed

➣ Preoperative anesthesia

Adults: 2 mg I.M. 60 to 90 minutes before surgery

➣ Balanced anesthesia

Adults: 2 mg I.V. shortly before anesthesia induction, or 0.5 to 1 mg I.V. in increments during anesthesia

Dosage adjustment

• Renal or hepatic impairment

• Elderly patients

Off-label uses

• Headache

• Symptomatic relief of ureteral colic

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

• head injury, ventricular dysfunction, coronary insufficiency, respiratory disease, renal or hepatic dysfunction

• history of drug abuse.

Administration

• Make sure solution is clear and free of particulates before giving.

• When using nasal spray, insert tip of the sprayer about ¼″ into nostril, point tip backwards, and administer one spray.

• Be aware that I.V. route is preferred for severe pain.

See Know that drug may cause infant respiratory distress in neonate of pregnant patient, especially if given within 2 hours of delivery.

Adverse reactions

CNS: drowsiness, sedation, dizziness, tremor, irritability, syncope, stimulation

CV: hypertension, hypotension, palpitations, bradycardia, tachycardia, extrasystole, arrhythmias

EENT: blurred vision, nasal congestion or dryness, dry or sore throat

GI: nausea, vomiting, constipation, epigastric distress, dry mouth, GI obstruction

GU: urinary retention or hesitancy, dysuria, early menses, decreased libido, erectile dysfunction

Hematologic: hemolytic anemia, hypoplastic anemia, thrombocytopenia, agranulocytosis, leukopenia, pancytopenia

Respiratory: thickened bronchial secretions, chest tightness, wheezing

Skin: urticaria, rash, diaphoresis

Other: increased or decreased appetite, weight gain, local stinging, anaphylactic shock, hypersensitivity reaction (with I.V. use)

Interactions

Drug-drug. CNS depressants: additive CNS effects

Drugs-herbs. Kava, St. John's wort, valerian: increased CNS depression

Drug-behaviors. Alcohol use: additive CNS effects

Patient monitoring

• Monitor respiratory status closely, especially after I.V. administration.

• Watch for signs and symptoms of withdrawal in long-term use and in opioid-dependent patients.

• Assess elderly patient closely for sensitivity to drug.

Patient teaching

• Teach patient how to use nasal spray properly.

• Emphasize importance of using drug exactly as prescribed.

• Caution patient that drug may be habit-forming.

• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.

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