byoo-TOR-fa-nole
High Alert
Contraindicated in:
Use Cautiously in:
prolonged use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome
;CV: hypertension, hypotension, palpitations
Derm: sweating, clammy feeling
EENT: blurred vision, diplopia, miosis (high doses)
GI: nausea, constipation, dry mouth, ileus, vomiting
Neuro: confusion, dysphoria, hallucinations, sedation, euphoria, floating feeling, headache, unusual dreams
Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND SLEEP-RELATED HYPOXEMIA)
Misc: allodynia, opioid-induced hyperalgesia,
physical dependence
,psychological dependence
, toleranceDrug-drug:
Use with benzodiazepines or other CNS depressants, including other opioids, nonbenzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol, may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
CYP3A4 inhibitors may ↑ levels and risk of toxicity.
CYP3A4 inducers may ↓ levels and effectiveness.
Drug-Natural Products:
Therapeutic Classification: opioid analgesics
Pharmacologic Classification: opioid agonists antagonists
Absorption: Well absorbed from IM sites and nasal mucosa.
Distribution: Extensively distributed to tissues.
Half-Life: 3–4 hr.
(analgesia)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IM | within 15 min | 30–60 min | 3–4 hr |
| IV | within min | 4–5 min | 2–4 hr |
| Intranasal | within 15 min | 1–2 hr | 4–5 hr |
Advise patient that butorphanol is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
Inform patient of potential for neonatal opioid withdrawal syndrome with prolonged use during pregnancy. Monitor neonate for signs and symptoms of withdrawal symptoms (irritability, hyperactivity and abnormal sleep pattern, high-pitched cry, tremor, vomiting, diarrhea, failure to gain weight); usually occur the first days after birth.
Instruct patient on proper use of nasal spray. See package insert for detailed instructions. Instruct patient to replace protective clip and clear cover after use and to store the unit in the child-resistant container. Caution patient that medication should not be used by anyone other than the person for whom it was prescribed. Excess medication should be disposed of as soon as it is no longer needed. To dispose of, unscrew cap, rinse bottle and pump with water, and dispose of in waste can.
NDC Code