Levorphanol

Levorphanol Brand Name– Levo-Dromoran

What is Levorphanol

Levorphanol is an opioid agonist indicated for pain severe enough to require an opioid analgesic and for which alternate treatments (e.g., non-opioid analgesics or opioid combination products) are inadequate.

Levorphanol has been useful in patients with chronic pain, and it may serve as an alternative option for patients when methadone fails to control pain or adverse effects limit use.

Indications

  • severe pain

Side Effects

  1. abdominal pain
  2. adrenocortical insufficiency
  3. amenorrhea
  4. amnesia
  5. apnea
  6. biliary obstruction
  7. bradycardia
  8. cardiac arrest
  9. coma
  10. confusion
  11. constipation
  12. cyanosis
  13. depression
  14. diaphoresis
  15. diplopia
  16. dizziness
  17. dyskinesia
  18. dyspepsia
  19. dysphoria
  20. euphoria
  21. flushing
  22. gonadal suppression
  23. gynecomastia
  24. headache
  25. hyperamylasemia
  26. hyperkinesis
  27. hyponatremia
  28. hypotension
  29. hypoventilation
  30. impaired cognition
  31. impotence (erectile dysfunction)
  32. infertility
  33. injection site reaction
  34. insomnia
  35. lethargy
  36. libido decrease
  37. miosis
  38. nausea
  39. neonatal opioid withdrawal syndrome
  40. nightmares
  41. orthostatic hypotension
  42. palpitations
  43. physiological dependence
  44. pruritus
  45. psychological dependence
  46. rash
  47. renal failure (unspecified)
  48. respiratory depression
  49. seizures
  50. serotonin syndrome
  51. SIADH
  52. sinus tachycardia
  53. suicidal ideation
  54. tolerance
  55. urinary retention
  56. urticaria
  57. vomiting
  58. withdrawal
  59. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • accidental exposure
  • acute abdomen
  • acute myocardial infarction
  • adrenal insufficiency
  • alcoholism
  • angina
  • asthma
  • biliary tract disease
  • bladder obstruction
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • CNS depression
  • coadministration with other CNS depressants
  • coma
  • constipation
  • cor pulmonale
  • dehydration
  • depression
  • diarrhea
  • driving or operating machinery
  • ethanol ingestion
  • ethanol intoxication
  • geriatric
  • GI disease
  • GI obstruction
  • head trauma
  • heart failure
  • hepatic disease
  • hypotension
  • hypothyroidism
  • hypovolemia
  • hypoxemia
  • ileus
  • increased intracranial pressure
  • infants
  • infertility
  • inflammatory bowel disease
  • intracranial mass
  • labor
  • myxedema
  • neonatal opioid withdrawal syndrome
  • neonates
  • obesity
  • obstetric delivery
  • oliguria
  • opiate agonist hypersensitivity
  • opioid overdose
  • opioid use disorder
  • orthostatic hypotension
  • pancreatitis
  • potential for overdose or poisoning
  • pregnancy
  • prostatic hypertrophy
  • psychosis
  • pulmonary disease
  • renal disease
  • renal impairment
  • reproductive risk
  • respiratory depression
  • respiratory insufficiency
  • scoliosis
  • seizure disorder
  • seizures
  • shock
  • sleep apnea
  • status asthmaticus
  • substance abuse
  • ulcerative colitis
  • urethral stricture
  • urinary retention

Interactions

  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Almotriptan
  • Alosetron
  • Alprazolam
  • Alvimopan
  • Amide local anesthetics
  • Amifampridine
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amobarbital
  • Amoxapine
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amphetamines
  • Anticholinergics
  • Apomorphine
  • Apraclonidine
  • Aripiprazole
  • Articaine; Epinephrine
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atenolol; Chlorthalidone
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine
  • Azelastine; Fluticasone
  • Azilsartan; Chlorthalidone
  • Baclofen
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzonatate
  • Benzphetamine
  • Benztropine
  • Bethanechol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Brexpiprazole
  • Brimonidine
  • Brimonidine; Brinzolamide
  • Brimonidine; Timolol
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bumetanide
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion; Naltrexone
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Cannabidiol
  • Capsaicin; Metaxalone
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
  • Carisoprodol
  • Cenobamate
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexbrompheniramine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chloral Hydrate
  • Chlorcyclizine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Citalopram
  • Clemastine
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clonidine
  • Clopidogrel
  • Clorazepate
  • Clozapine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Crofelemer
  • Cyclizine
  • Cyclobenzaprine
  • Cyproheptadine
  • Dantrolene
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desflurane
  • Desipramine
  • Desmopressin
  • Deutetrabenazine
  • Dexchlorpheniramine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dexpanthenol
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Promethazine
  • Diazepam
  • Dicyclomine
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Dolasetron
  • Doxepin
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Droperidol
  • Eletriptan
  • Eltrombopag
  • Eluxadoline
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enflurane
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Escitalopram
  • Esketamine
  • Estazolam
  • Eszopiclone
  • Ethacrynic Acid
  • Ethanol
  • Etomidate
  • Fenfluramine
  • Fesoterodine
  • Flavoxate
  • Flibanserin
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fospropofol
  • Frovatriptan
  • Furosemide
  • Gabapentin
  • General anesthetics
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guanabenz
  • Guanfacine
  • Haloperidol
  • Halothane
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Imipramine
  • Indacaterol; Glycopyrrolate
  • Indapamide
  • Isocarboxazid
  • Isoflurane
  • Ketamine
  • Lasmiditan
  • Lemborexant
  • Levobupivacaine
  • Levocetirizine
  • Levomilnacipran
  • Lidocaine
  • Lidocaine; Prilocaine
  • Lincosamides
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lofexidine
  • Loop diuretics
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Lorazepam
  • Lorcaserin
  • Loxapine
  • Lumateperone
  • Lurasidone
  • Magnesium Salts
  • Maprotiline
  • Melatonin
  • Mepenzolate
  • Meperidine; Promethazine
  • Mephobarbital
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Meprobamate
  • Metaxalone
  • Methadone
  • Methamphetamine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
  • Methohexital
  • Methscopolamine
  • Methyclothiazide
  • Methyldopa
  • Methylene Blue
  • Methylphenidate
  • Metoclopramide
  • Metolazone
  • Metyrapone
  • Metyrosine
  • Midazolam
  • Milnacipran
  • Minocycline
  • Mirtazapine
  • Molindone
  • Monoamine oxidase inhibitors
  • Nabilone
  • Nalbuphine
  • Naloxone
  • Naltrexone
  • Naproxen; Sumatriptan
  • Naratriptan
  • Nefazodone
  • Nesiritide, BNP
  • Nitroglycerin
  • Nortriptyline
  • Octreotide
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Ondansetron
  • Orphenadrine
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Paliperidone
  • Palonosetron
  • Papaverine
  • Paroxetine
  • Pegvisomant
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Perampanel
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenelzine
  • Phenobarbital
  • Phenylephrine; Promethazine
  • Pimozide
  • Pramipexole
  • Pramlintide
  • Prasugrel
  • Pregabalin
  • Prilocaine
  • Prilocaine; Epinephrine
  • Primidone
  • Procaine
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Propantheline
  • Propofol
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Rasagiline
  • Risperidone
  • Ritonavir
  • Rizatriptan
  • Ropinirole
  • Ropivacaine
  • Rotigotine
  • Safinamide
  • Scopolamine
  • Secobarbital
  • Selegiline
  • Serotonin-Receptor Agonists
  • Serotonin-Receptor Antagonists
  • Sertraline
  • Sevoflurane
  • Sibutramine
  • Sildenafil
  • Sodium Oxybate
  • Solifenacin
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Sumatriptan
  • Suvorexant
  • Tapentadol
  • Tasimelteon
  • Tedizolid
  • Temazepam
  • Tetrabenazine
  • Thalidomide
  • Thiazide diuretics
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Ticagrelor
  • Tizanidine
  • Tolterodine
  • Torsemide
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Triamterene
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trihexyphenidyl
  • Trimethobenzamide
  • Trimipramine
  • Triprolidine
  • Trospium
  • Valerian, Valeriana officinalis
  • Valproic Acid, Divalproex Sodium
  • Venlafaxine
  • Vigabatrin
  • Vilazodone
  • Vortioxetine
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem