levorphanol

Adult Dosing

Moderate-severe pain

2 mg PO q6-8 hrs; may increase up to 3 mg q6-8 hrs; titrate dose q72 hrs
Dosage should be individualized based on degree of pain and clinical setting

Pediatric Dosing

Safety and efficacy in pediatric population have not been established

Indications ⬆ ⬇

Management of moderate to severe pain where an opioid analgesic is appropriate

Contraindications ⬆ ⬇

Hypersensitivity to any of the ingredients of the product, including dextromethorphan
Respiratory depression
Increased ICP
MI
Hypotension

Black Box Warnings ⬆ ⬇

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment

Severe impairment: Reduction of initial dose recommended, dose adjustments not defined

Hepatic Dose Adjustment

Hepatic impairment: Reduction of initial dose recommended, dose adjustments not defined

Warnings/Precautions ⬆ ⬇

It may cause respiratory depression in elderly, debilitated patients. Therefore reduce dose to 50% in patient in any condition affecting respiratory reserve or in conjunction with other drugs affecting the respiratory center
If used in conjunction with alcohol, other opioids, or illicit drugs, it may result in additive CNS depressive effects, including respiratory depression, hypotension, profound sedation, coma, or death
Similar to other opioids, it is a Schedule II controlled substance with an abuse liability
Avoid use in head injury, other intracranial lesions or a pre-existing intracranial hypertension, as it may exaggerate elevation of cerebrospinal fluid pressure
Avoid administration in patients with gastrointestinal obstruction, especially paralytic ileus because it diminishes propulsive peristaltic waves in the gastrointestinal tract and may prolong the obstruction
Use with caution in patients with biliary tract disease, including acute pancreatitis, as it may cause spasm of the Sphincter of Oddi and diminish biliary and pancreatic secretions
Caution must be used with potentially hazardous activities such as driving and operating machinery
Delirium tremens have been reported

Cautions: Use cautiously in

Severe renal impairment
Hepatic impairment
Elderly or debilitated
Hypothyroidism
Addison’s disease
Toxic psychosis
Prostatic hypertrophy or urethral stricture
Acute alcoholism or delirium tremens
Drug dependency
Seizure disorder
Concomitant use with MAOI's

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:C

Breastfeeding: Safety unknown. Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.

Adverse Reactions ⬆ ⬇

CNS: Confusion, sedation, mood disturbances, dysphoria, euphoria, dizziness, floating feeling, hallucinations, headache, unusual dreams
EENT: Blurred vision, diplopia, miosis
RESP: Respiratory depression, bronchospasm, apnea, hypoventilation
CV: Hypotension, bradycardia
GI: Constipation, dry mouth, nausea, vomiting, biliary spasm
GU: Urinary retention
DERM: Flushing, sweating, pruritis, rash
MISC: Physical dependence, psychological dependence, tolerance, renal failure, risk of suicide, coma, seizure

Clinical Pharmacology ⬆ ⬇

Opioid agonist; alters perception and response to pain by binding to opiate receptors in the CNS; produces generalized CNS depression
Metabolized by liver
Excreted in urine
Half-life: 11-16 hrs

Brands and Availability ⬆ ⬇

US Trade Name(s)

Only generic available

US Availability

levorphanol (generic)

TABS: 2 mg

Canadian Trade Name(s)

Canadian Availability

UK Trade Name(s)

UK Availability

Australian Trade Name(s)

Australian Availability

Classification ⬆ ⬇

Analgesics

Opioid Analgesics
Opioid Agonists

Pill ⬆

Drug Name: L-Dromoran 2 MG Oral Tablet

Ingredient(s): Levorphanol

Imprint: LEVO;3251

Color(s): White

Shape: Round

Size (mm): 6.00

Score: 2

Inactive Ingredient(s): lactose / corn starch / stearic acid / talc

Drug Label Author:
Valeant Pharmaceuticals International

DEA Schedule:
CII

Drug Name: Levorphanol 2 MG Oral Tablet