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
- abdominal pain
- adrenocortical insufficiency
- amenorrhea
- amnesia
- apnea
- biliary obstruction
- bradycardia
- cardiac arrest
- coma
- confusion
- constipation
- cyanosis
- depression
- diaphoresis
- diplopia
- dizziness
- dyskinesia
- dyspepsia
- dysphoria
- euphoria
- flushing
- gonadal suppression
- gynecomastia
- headache
- hyperamylasemia
- hyperkinesis
- hyponatremia
- hypotension
- hypoventilation
- impaired cognition
- impotence (erectile dysfunction)
- infertility
- injection site reaction
- insomnia
- lethargy
- libido decrease
- miosis
- nausea
- neonatal opioid withdrawal syndrome
- nightmares
- orthostatic hypotension
- palpitations
- physiological dependence
- pruritus
- psychological dependence
- rash
- renal failure (unspecified)
- respiratory depression
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- suicidal ideation
- tolerance
- urinary retention
- urticaria
- vomiting
- withdrawal
- 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