Butorphanol

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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

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