Butorphanol

Butorphanol Brand Names- Stadol | Stadol NS

What is Butorphanol

Butorphanol tartrate is a synthetic parenteral opiate agonist-antagonist. Although it is structurally related to morphine, butorphanol is more similar in action to nalbuphine, another agonist-antagonist.

Butorphanol is available parenterally for treating moderate to severe pain and as a nasal spray that has been used to treat migraine.

Although studies suggest equianalgesic parenteral doses are as effective as morphine, clinical response may indicate otherwise, perhaps due to the development of tolerance.

Butorphanol does not offer significant advantages over pure opiate-agonists in the treatment of acute pain or cancer pain.

Butorphanol is also used to provide preoperative sedation and analgesia, and to supplement surgical anesthesia. Butorphanol injection was approved by the FDA in 1978; the nasal spray was approved in 1991.

Although butorphanol was not a controlled substance in the United States when it was originally introduced, the DEA recommended in June 1997 that both the injection and the nasal spray be classified as a controlled substance.

Indications

1. general anesthesia induction
2. general anesthesia maintenance
3. headache
4. migraine
5. moderate pain
6. preanesthesia
7. pruritus
8. severe pain

For treatment of moderate pain to severe pain including abdominal, orthopedic, migraine, headache, or postoperative pain when use of an opioid analgesic is appropriate

Side Effects

1. abdominal pain
2. adrenocortical insufficiency
3. agitation
4. amenorrhea
5. anorexia
6. anxiety
7. apnea
8. asthenia
9. blurred vision
10. bradycardia
11. chest pain (unspecified)
12. confusion
13. constipation
14. cough
15. depression
16. diaphoresis
17. dizziness
18. drowsiness
19. dysgeusia
20. dysphoria
21. dyspnea
22. edema
23. epistaxis
24. euphoria
25. gonadal suppression
26. hallucinations
27. headache
28. hostility
29. hypertension
30. hyponatremia
31. hypotension
32. impotence (erectile dysfunction)
33. increased intracranial pressure
34. infertility
35. insomnia
36. lethargy
37. libido decrease
38. nasal congestion
39. nasal irritation
40. nausea
41. neonatal opioid withdrawal syndrome
42. orthostatic hypotension
43. otalgia
44. palpitations
45. paresthesias
46. peripheral vasodilation
47. pharyngitis
48. physiological dependence
49. pruritus
50. psychological dependence
51. rash
52. respiratory depression
53. rhinitis
54. serotonin syndrome
55. SIADH
56. sinus tachycardia
57. sinusitis
58. syncope
59. tinnitus
60. tolerance
61. tremor
62. urinary retention
63. urticaria
64. vomiting
65. withdrawal
66. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• accidental exposure
• acute myocardial infarction
• adrenal insufficiency
• alcoholism
• angina
• asthma
• breast-feeding
• cardiac disease
• chronic obstructive pulmonary disease (COPD)
• coadministration with other CNS depressants
• constipation
• depression
• driving or operating machinery
• geriatric
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypothyroidism
• ileus
• increased intracranial pressure
• inflammatory bowel disease
• intracranial mass
• labor
• myxedema
• neonatal opioid withdrawal syndrome
• obstetric delivery
• opiate agonist hypersensitivity
• potential for overdose or poisoning
• pregnancy
• pulmonary disease
• renal failure
• renal impairment
• respiratory depression
• respiratory insufficiency
• substance abuse
• ulcerative colitis
• ventricular dysfunction

Interactions

• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Alfentanil
• Alprazolam
• Amifampridine
• Amitriptyline; Chlordiazepoxide
• Amoxapine
• Anticholinergics
• Aripiprazole
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Baclofen
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benztropine
• Brexpiprazole
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion; Naltrexone
• Buspirone
• Cannabidiol
• Capsaicin; Metaxalone
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Cariprazine
• Carisoprodol
• Cenobamate
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chloral Hydrate
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorzoxazone
• Clobazam
• Clonazepam
• Clorazepate
• Clozapine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Cyclobenzaprine
• Dantrolene
• Deutetrabenazine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Diazepam
• Dicyclomine
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Dronabinol
• Droperidol
• Entacapone
• Esketamine
• Estazolam
• Eszopiclone
• Ethanol
• Ezogabine
• Fentanyl
• Flavoxate
• Flibanserin
• Fluoxetine; Olanzapine
• Flurazepam
• Gabapentin
• General anesthetics
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Haloperidol
• Homatropine; Hydrocodone
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Iloperidone
• Indacaterol; Glycopyrrolate
• Lasmiditan
• Levocetirizine
• Levomethadyl
• Levorphanol
• Lofexidine
• Lorazepam
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Mepenzolate
• Meperidine
• Meperidine; Promethazine
• Meprobamate
• Metaxalone
• Methadone
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methscopolamine
• Midazolam
• Minocycline
• Mirtazapine
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Nabilone
• Nalbuphine
• Nalmefene
• Naloxone
• Naltrexone
• Naproxen; Sumatriptan
• Nefazodone
• Olanzapine
• Orphenadrine
• Oxazepam
• Oxybutynin
• Oxycodone
• Oxymetazoline
• Oxymorphone
• Paliperidone
• Pentazocine
• Pentazocine; Naloxone
• Phenothiazines
• Phenylephrine
• Phenylephrine; Promethazine
• Pimozide
• Pramipexole
• Pregabalin
• Propantheline
• Propoxyphene
• Quazepam
• Quetiapine
• Rasagiline
• Remifentanil
• Risperidone
• Ropinirole
• Rotigotine
• Scopolamine
• Sedating H1-blockers
• Solifenacin
• Sufentanil
• Sumatriptan
• Tapentadol
• Temazepam
• Tetrabenazine
• Thalidomide
• Thiothixene
• Tizanidine
• Tolcapone
• Tolterodine
• Tramadol
• Trazodone
• Triazolam
• Tricyclic antidepressants
• Trihexyphenidyl
• Trimethobenzamide
• Trospium
• Vigabatrin
• Vilazodone
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolpidem