Butorphanol

DEA Class; Rx

Common Brand Names; Stadol

Semisynthetic mixed opiate agonist-antagonist; partial mu-receptor agonist with a ceiling to its pharmacological effects
Immediate-release parenteral form used for moderate to severe pain; transdermal and buccal forms used for continuous therapy for chronic severe pain
Sublingual tablets, dermal implant, and extended-release subcutaneous injection are used for opioid dependence in conjunction with the Drug Addiction Treatment Act (DATA)

Indicated for pain when use of opioid analgesic is appropriate

Indicated for labor pain in full-term (37 weeks gestation or more) women without fetal distress in early labor

Absolute: opioid dependence, respiratory depression, respiratory failure

Relative: cardiac arrhythmias, cardiovascular disease, coronary insufficiency, myocardial infarction, toxin-mediated diarrhea

• Sedation (43%)
• Dizziness (19%)
• Nasal congestion (13%)
• Nausea and/or vomiting (13%)
• Insomnia (11%)
• 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
• Apnea
• Increased/decreased BP
• Bradycardia
• Chest pain
• Respiratory depression
• Tachycardia

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

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)