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levorphanol
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 II 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. by children, can result in fatal levorphanol 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
Adult Dosing .
Dosage forms: TAB: 2 mg
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, mod-severe
- [opioid-naive pts]
- Dose: individualize dose PO q6-8h prn; Start: 1-2 mg PO q6-8h prn, then may incr. to up to 3 mg PO q6-8h prn; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; decr. start dose at least 50% in debilitated pts 65 yo and older and titrate w/ caution; taper dose by 25-50% q2-4 days to D/C if prolonged or long-term use
- [opioid-experienced pts]
- Dose: individualize dose PO q6-8h prn; Start: individualize based on current opioid intake, see pkg insert for conversion; Info: use lowest effective dose, shortest effective tx duration; may adjust dose q72h; consider low start dose, titrate slowly in pts 65 yo and older; decr. start dose at least 50% in debilitated pts 65 yo and older and titrate w/ caution; taper dose by 25-50% q2-4 days to D/C if prolonged or long-term use
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- severe impairment: decr. usual start dose, amount not defined
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.