Select a medication above to begin.
butorphanol
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; proper dosing and titration essential to decr. resp. depression risk
Addiction, Abuse, and Misuse
opioid agonist Schedule IV controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, esp. in children, can result in fatal butorphanol overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. butorphanol levels and may cause potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer
Adult Dosing .
Dosage forms: INJ: 1 mg per mL, 2 mg per mL
pain, mod-severe
- [0.5-2 mg IV q3-4h prn]
- Start: 1 mg IV q3-4h prn; Max: 4 mg/dose IM; Alt: start 2 mg IM q3-4h prn, may adjust dose to 1-4 mg IM q3-4h prn; Info: use lowest effective dose, shortest effective tx duration
analgesia, preop
- [2 mg IM x1]
- Start: 60-90min before surgery
anesthesia adjunct
- [2 mg IV x1, then 0.5-1 mg IV prn]
- Start: before induction
renal dosing
- [pain, moderate-severe]
- renal impairment: start 0.5 mg IV q6h prn or 1 mg IM q6h prn
- HD/PD: not defined
- [all other indications]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [pain, moderate-severe]
- hepatic impairment: start 0.5 mg IV q6h prn or 1 mg IM q6h prn
- [all other indications]
- hepatic impairment: not defined
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.