Butorphanol

Moderate to severe pain, Anaesthesia

Pain Parenteral Indicated for pain when use of opioid analgesic is appropriate IV: 1 mg IV q3-4hr PRN; dosage range 0.5-2 mg q3-4hr IM: 2 mg IM q3-4 hr; dosage range 1-4 mg q3-4hr Intranasal Initial: 1 mg (1 spray in 1 nostril); may repeat once after 60-90 min if inadequate pain relief Depending on pain severity, by give initial dose of 2 mg (1 spray in each nostril); patient must remain recumbant; do not repeat this dose Maintenance: 1 mg (1 spray in 1 nostril) q3-4hr prn Balanced Anesthesia Parenteral 2 mg IV before induction and/or 0.5-1 mg increments during anesthesia (higher dose may be required, up to 0.06 mg/kg, or 4 mg/70 kg) Total cumulative dose varies; typically ranges between 4-12.5 mg (0.06-0.18 mg/kg) Labor Pain Indicated for labor pain in full-term (37 weeks gestation or more) women without fetal distress in early labor 1-2 mg/dose IV/IM; may repeat PRN q4hr Decrease dose if concomitantly used with other analgesics or CNS depressants Do not administer within 4 hr of anticipated delivery Preoperative & Preanesthesia 2 mg IM 60-90 minutes preop This dose is approximately equipotent to morphine 10 mg or meperidine 80 mg

<18 years old: Not recommended

Renal Impairment Parenteral Decrease initial dose by 50% (0.5 mg IV and 1 mg IM) Increase dose interval from q4hr to q6hr Intranasal 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn

Pain Elderly Parenteral Decrease initial dose by 50% (0.5 mg IV and 1 mg IM) Increase dose interval from q4hr to q6hr Intranasal 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn

Hepatic Impairment Parenteral Decrease initial dose by 50% (0.5 mg IV and 1 mg IM) Increase dose interval from q4hr to q6hr Intranasal 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn

IV Administration pH: 3.0-5.5 IM/IV injection

Opiate-dependent patients who have not been detoxified; acute resp depression; pregnancy.

Drug abuse, emotional lability, head injury, hepatic/renal impairment, incr ICP, GI/urinary obstruction, BPH, hypothyroidism Less risk of respiratory sedation than with pure opioid agonist May produce withdrawal in opioid dependent pts Avoid alcohol

C Pregnancy Category: C; D if used for prolonged periods or near term Lactation: excreted in breast milk, but infant likely exposed to insignificant amounts (AAP Committee states compatible w/ nursing)

Additive depressant effects with other CNS depressants e.g. general anaesthetics, phenothiazines or other tranquilizers, sedatives, hypnotics, antihistamines or alcohols. Contraindicated (2) alvimopan olanzapine/samidorphan

>10% Sedation (43%),Dizziness (19%),Nasal congestion (13%),Nausea and/or vomiting (13%),Insomnia (11%) 1-10% Anorexia,Anxiety,Blurred vision,Bronchitis,Confusion,Constipation,Cough,Dizziness,Dry mouth,Dyspnea,Ear pain,Epistaxis,Euphoria,Floating feeling,Headache,Lethargy,Nasal irritation,Nervousness,Paresthesia,Palpitations,Pharyngitis,Pruritis,Rhinitis,Sensation of heat,Sinus congestion,Sinusitis,Stomach pain,Sweating/clammy,Taste abnormalities,Tinnitus,Tremor,URI,Vasodilation <1% Apnea,Increased/decreased BP,Bradycardia,Chest pain,Respiratory depression,Tachycardia

Butorphanol is a phenanthrene derivative with opioid agonist and antagonist properties. It has central analgesic actions and produces generalised CNS depression. It also alters perception of and response to pain by binding to opiate receptors in the CNS.