Butorphanol Tartrate

The typical dosage of butorphanol tartrate depends on the form used and the severity of the pain:

For Injectable Form:

• Initial Dose: 1 mg to 2 mg administered intravenously or intramuscularly, repeated every 3 to 4 hours as needed.

For Nasal Spray:

• Initial Dose: One spray (1 mg) in one nostril, which may be repeated in 60 to 90 minutes if needed. For severe pain, one spray in each nostril may be used.

Butorphanol tartrate is contraindicated in patients with:

• Hypersensitivity to butorphanol or any of the other components of the formulation.
• Significant respiratory depression, particularly in unmonitored settings or without resuscitative equipment.
• Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment.
• Known or suspected gastrointestinal obstruction, including paralytic ileus.

Patients using butorphanol tartrate should be advised to:

• Use the medication exactly as prescribed and not exceed the recommended dose, particularly with the nasal spray form, to avoid serious side effects.
• Avoid alcohol and other central nervous system depressants, as these can enhance the sedative and respiratory depressant effects of butorphanol.
• Report any signs of respiratory depression, severe drowsiness, or confusion to their healthcare provider immediately.
• Be cautious when performing activities that require alertness, such as driving or operating machinery, as butorphanol can cause dizziness, drowsiness, and impaired judgment.
• Discuss with their healthcare provider any history of substance use disorder, as butorphanol can be habit-forming.

• Drowsiness or dizziness
• Nausea or vomiting
• Sweating
• Headache
• Dry mouth

Serious side effects can include:

• Respiratory Depression: Particularly in opioid-naive patients or at high doses.
• Dependency and Withdrawal: Long-term use can lead to physical dependence and withdrawal symptoms if the medication is abruptly discontinued.
• Allergic Reactions: Such as rash, itching, swelling, or difficulty breathing.

• Respiratory Depression: Butorphanol has the potential to cause life-threatening respiratory depression, particularly when used in higher doses or in combination with other CNS depressants.
• Dependency and Abuse: Although butorphanol has a lower potential for abuse compared to other opioids, it can still be habit-forming, especially with prolonged use.
• Impaired Mental and Physical Abilities: Patients should be warned about the potential for butorphanol to impair cognitive and motor skills, which can affect their ability to drive or operate heavy machinery.

Butorphanol tartrate may interact with other medications, including:

• CNS Depressants: Such as benzodiazepines, opioids, and alcohol, which can enhance the sedative and respiratory depressant effects.
• MAO Inhibitors: Concomitant use may increase the risk of serotonin syndrome or other serious side effects.
• Serotonergic Drugs: Such as SSRIs, SNRIs, or triptans, which can increase the risk of serotonin syndrome.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for moderate to severe pain include:

• Other Opioid Analgesics: Such as morphine, oxycodone, or hydromorphone, depending on the patient’s needs and the clinical situation.
• Non-Opioid Analgesics: Such as NSAIDs, acetaminophen, or adjuvant therapies like anticonvulsants for specific types of pain.
• Regional Anesthesia: For specific types of pain, such as nerve blocks or epidurals.

The choice of treatment depends on the type and severity of pain, patient preferences, and the presence of any co-existing health conditions.