butorphanol tartrate

Drug Name

Generic Name : butorphanol tartrate

Brand Name: Stadol

Classification:  Opioid agonist-antagonist analgesic

Pregnancy Category C (during pregnancy)
Pregnancy Category D (during labor and delivery)
Controlled Substance C-IV

Dosage & Route
Parenteral
  • Moderate to severe pain
    • Adult: 1-4 mg via IM injection or 0.5-2 mg IV injection every 3-4 hr.
  • Anesthesia
    • Adult: As premedicant before surgery: 2 mg given via IM injection 60-90 minutes before surgery. As supplement in balanced anesthesia: Doses are given via IV admin; 2 mg shortly before induction and/or an incremental dose of 0.5-1 mg (up to 0.06 mg/kg) during anesthesia. Total dose may vary but usually ranges from 4-12.5 mg.
Nasal
  • Moderate to severe pain
  • Adult: Initially, 1 mg, repeated after 60-90 minutes if necessary; may be repeated after 3-4 hr when necessary. For severe pain, initial dose can be 2 mg, repeated only after 3-4 hr.
  • Elderly: Initial dose: 1/2 usual adult dose. Recommended dose interval: at least 6 hr.
  • Renal impairment: Initial dose: 1/2 usual adult dose. Recommended dose interval: at least 6 hr.
  • Hepatic impairment: Initial dose: 1/2 usual adult dose. Recommended dose interval: at least 6 hr.
Therapeutic actions
  • Butorphanol is a phenanthrene derivative with opioid agonist and antagonist properties. It has central analgesic actions and produces generalized CNS depression. It also alters perception of and response to pain by binding to opiate receptors in the CNS.
    • Onset: IM or nasal admin: 10-15 minutes.
    • Duration: 3-4 hr (IM); 5 hr (nasal).
    • Absorption: Peak plasma concentrations after 0.5-1 hr (IM/nasal); 1-1.5 hr (oral).
    • Distribution: Crosses the placenta and enters breast milk. Protein-binding: 80%.
    • Metabolism: Hepatic; extensive 1st-pass metabolism.
    • Excretion: Mainly in the urine; 11-14% of parenteral dose excreted in bile; 3 hr (elimination half-life).
Indications
  • Relief of moderate to severe pain
  • Nasal spray: Relief of migraine headache pain and relief of moderate to severe pain
  • For preoperative or preanesthetic medication, to supplement balanced anesthesia, and to relieve prepartum pain (parenteral)
Adverse effects
  • Sedation, dizziness, physical dependence, with or without psychological dependence; dyspnea, confusion, headache, nausea, vomiting, drowsiness, constipation; hallucinations, mental depression, HTN and paradoxical CNS excitation (especially in children); rash, syncope, tinnitus, vertigo, diaphoresis, withdrawal syndrome.
  • Potentially Fatal: Respiratory depression, convulsions.
Contraindications
  • Opiate-dependent patients who have not been detoxified; acute respiratory depression; pregnancy.
Nursing considerations
Assessment
  • History: Hypersensitivity to butorphanol, physical dependence on a narcotic analgesic, pregnancy, lactation, bronchial asthma, COPD, increased intracranial pressure, acute MI, ventricular failure, coronary insufficiency, hypertension, biliary tract surgery, renal or hepatic impairment
  • Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision; pulse, auscultation, BP; R, adventitious sounds; bowel sounds, normal output; LFTs, renal function tests
Interventions
  • Ensure that opioid antagonist facilities for assisted or controlled respiration is readily available during parenteral administration.
Teaching points
  • You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving, performing other tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals).
  • Report severe nausea, vomiting, palpitations, shortness of breath or difficulty breathing, nasal lesions or discomfort (nasal spray).