Butorphanol Tartrate

Drug Class: Butorphanol Tartrate > Butorphanol > Fully Synthetic Opioid > Opioids > Opioid Agonist > Analgesic.

Uses

Doctors most commonly prescribe butorphanol tartrate to relieve migraine pain but also to reduce pre-operative, perioperative and post operative pain along with easing the pain of childbirth. Learn More About Butorphanol Tartrate Uses

Administration/Dosage

Butorphanol tartrate is available for human consumption under the brand name Stadol. Veterinary name brand injectable forms of butorphanol tartrate include Torbutrol and Torbugesic. Stadol is available as an intravenous or intramuscular injectable or as a nasal spray.

Each ml of the injectable form contains 1 or 2 mg of butorphanol tartrate. A nurse injects butorphanol tartrate into an IV or muscle. Intravenous injection of butorphanol tartrate may be administered 0.5 mg to 2 mg every three to four hours. Typical dosing range for intramuscular injection is 1 mg to 4 mg every three to four hours.

Every dose of spray administers 1 mg of butorphanol tartrate. Butorphanol tartrate is absorbed in the mucosal lining of the nasal passages. You must prime the butorphanol tartrate spray unit before using. If you do not use the unit for 48 hours or more, the unit will need to be re-primed. Your prescribing physician may recommend an initial dose for nasal spray of 1 mg, or one spray in one nostril. Do not spray into both nostrils unless directed to do so by a physician. You may take an additional 1 mg can be taken if your pain persists after 60-90 minutes.

In human studies, researchers noted sedation at doses of 0.5 mg butorphanol tartrate or more. Narcosis, or unconsciousness, may occur after doses of 10 to 12 mg butorphanol tartrate administered intravenously over 15 minutes. People who receive doses of 1 mg or more may feel nauseated.

Medical experts do not recommend butorphanol tartrate use for children under the age of 18. Medical research has not yet established safety and efficacy of butorphanol tartrate for this age group. Administer butorphanol tartrate only under the direct supervision of a pediatrician.

Older patients may be more sensitive to the effects of butorphanol tartrate, especially dizziness, drowsiness, lightheadedness, nausea, stuffy nose and vomiting. As a person ages, his risk for decreased kidney function rises, which means medications remain in the system longer. Older patients face an increased risk for toxic reactions associated with butorphanol tartrate. Physicians should prescribe half-strength initial doses for patients over the age of 65 until tolerance and clearance is established.

Your doctor may have recommended you take butorphanol tartrate on a regular dosing schedule to provide round-the-clock relief from pain. If you miss a dose, take the missed dose as soon as possible. If it is nearly time to take another dose, skip the missed dose and resume your normal schedule.

Tell the prescribing caregiver if butorphanol tartrate stops working to relieve your symptoms. This could be a sign of increased tolerance to opioids. Do not take more butorphanol tartrate than prescribed to relieve symptoms unless directed to do so by a physician. Increasing your dose could result in dangerous or fatal overdose.

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Action

Medical experts classify butorphanol tartrate as an opioid analgesic, which means it works on your central nervous system, or CNS, to provide pain relief. Butorphanol tartrate binds to the mu and kappa pain receptors in your brain and CNS. While binding to mu receptors provides sedation and pain relief, binding to kappa receptors may result in hallucinations, delusions and other psychotic episodes.

Butorphanol tartrate is fast acting. You will begin to feel relief from pain within just a few minutes of receiving butorphanol tartrate via IV. It takes about 15 minutes for butorphanol tartrate to take effect after an intramuscular, or IM, injection or spray. Peak analgesic effect takes place 30 to 60 minutes after IV or IM administration, one to two hours for nasal spray. Duration of analgesia depends on dosing and severity of pain, among other factors, but typically lasts three to four hours for IV or IM administration and four to five hours for nasal spray.

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Precautions

Do not take butorphanol tartrate if you allergic to it or any other opioids, such as codeine or morphine. An allergic reaction is a serious medical emergency that can deteriorate rapidly into a life or death situation. Discontinue butorphanol tartrate immediately and seek medical help at the first symptom of an allergic reaction. Symptoms of an allergic reaction include hives, difficulty breathing or swelling of the face, lips or tongue.

Tell your doctor if you have kidney problems. She may reduce your dosage to half or prescribe a different medication to relieve your pain. Your physician will prescribe dosage based on how well you tolerate butorphanol tartrate and how quickly your kidneys can clear the medication from your body. Patients with a history of kidney problems should not take butorphanol tartrate more frequently than once every six hours.

Binding with the kappa receptors means butorphanol tartrate may make your heart and work harder, affecting especially the part of your circulatory system that goes from your heart to your lungs and back to your heart again. Patients with a history of heart disease or heart blood vessel disease should limit their use of butorphanol tartrate to situations where the benefits clearly outweigh the risks.

Discuss your medical history with the prescribing physician before taking butorphanol tartrate. This medication may aggravate your condition or hinder treatment. Conversely, your illness or treatment for that illness may change the way butorphanol tartrate works in your body.

Tell your physician about any significant illnesses or conditions, including:

  • Brain Tumor, Head Injuries or Increased Pressure in the Head.
  • Breathing Problems such as COPD, Cor Pulmonale or Hypoxia.
  • Central Nervous System Disease.
  • Drug dependence.
  • Heart Attack.
  • Heart or Blood Vessel Problems.
  • High Blood Pressure.
  • Kidney Disease.
  • Liver Disease.

Butorphanol tartrate may make you dizzy, drowsy or impair your ability to make decisions, especially within the first hour after initial doses. Do not drive a motor vehicle, operate heavy machinery or participate in potentially risk behavior soon after taking this medication. Alcohol and some medications may enhance this effect.

Butorphanol tartrate may be habit forming. To avoid developing dependence to butorphanol tartrate and other opioids, take this medication exactly as prescribed by your physician. Do not take higher doses or consume this drug more frequently than prescribed. Discontinue use when your doctor advises you to stop using butorphanol tartrate.

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Warnings

Butorphanol tartrate may cause extreme high blood pressure. To combat sudden acute hypertension, a doctor will discontinue use of butorphanol tartrate and administer drugs intended to lower blood pressure. If you are not physically dependent on opioids, your physician will administer naloxone to further ease hypertension. Naloxone will cause unpleasant withdrawal symptoms in opioid-dependent individuals, so tell your doctor if you might be dependent on narcotics.

Butorphanol tartrate crosses placental barriers and can pass into human milk. Medical researchers are still working to establish whether taking butorphanol tartrate during pregnancy will harm an unborn child. Tell the prescribing physician if you are pregnant or plan to become pregnant while taking butorphanol tartrate. Do not breastfeed your baby while taking butorphanol tartrate.

When it is nearly time to stop taking butorphanol tartrate, wean yourself from this medication by taking successively smaller doses at less frequent intervals. Do not stop taking butorphanol tartrate suddenly unless a doctor tells you to do so. Abrupt cessation may cause unpleasant symptoms of withdrawal. Tell your doctor or seek out a rehabilitation specialist if withdrawal symptoms prevent you from discontinuing butorphanol tartrate.

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Drug Interactions

Do not take butorphanol tartrate if you are sensitive to the effects of the preservative, benzethonium chloride.

Butorphanol tartrate can interact with other drugs in harmful or unintended ways. Give the prescribing physician and pharmacist filling the order a list of all your medications, including prescriptions, non-prescription drugs, herbal remedies and dietary supplements. Do not start, stop or change the way you take any medication without first discussing it with your doctor.

Sodium oxybate, or GHB, increases the risk for dangerous drug interactions with butorphanol tartrate. Do not take butorphanol tartrate if you have taken GHB in the past 14 days. Taking butorphanol tartrate while sodium oxybate is still in your system can cause dangerous, even fatal, events. Nasal decongestants may delay the time it takes for butorphanol to work. Cimetidine increases the risk for side effects associated with butorphanol. Naltrexone or rifamycins, especially rifampin, can lower butorphanol's effectiveness.

It is especially important that you tell your doctor and pharmacist if you are taking any of the following medications:

  • Alfentanil
  • Alphaprodine
  • Codeine
  • Dihydrocodeine
  • Fentanyl
  • Fospropofol
  • Hydrocodone
  • Hydromorphone
  • Levorphanol
  • Meperidine
  • Methadone
  • Morphine
  • Morphine Sulfate Liposome
  • Oxycodone
  • Oxymorphone
  • Propoxyphene
  • Sufentanil
  • Tapentadol

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Side effects

Patients have reported side effects while using butorphanol tartrate. Most of the common side effects are not serious and resolve themselves. Continue using butorphanol tartrate but contact your doctor if the common side effects become intolerable or do not go away.

Common side effects include:

  • Anxiety.
  • Blurred vision.
  • Confusion.
  • Constipation.
  • Dizziness.
  • Dry mouth.
  • Euphoria.
  • Flu-like symptoms.
  • Headache
  • Heart palpitations.
  • Insomnia.
  • Lethargy.
  • Nausea.
  • Nervousness.
  • Respiratory problems.
  • Stomach pain.
  • Tremors.
  • Vomiting.

Some side effects can be serious, even life threatening. Discontinue butorphanol tartrate use immediately and seek out professional medical assistance if you experience any serious side effects.

Serious side effects:

  • Fainting.
  • Hallucinations.
  • Headache.
  • Hives.
  • Irregular or Pounding Heartbeat.
  • Labored or Slowed Breathing.
  • Lightheadedness.
  • Rash.

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Overdose

Drug overdose is a medical emergency that may result in death. If you suspect you or someone you know has taken too much butorphanol tartrate or any other drug, immediately contact poison control center at 1-800-222-1222 or go to the emergency room. Overdose symptoms include:

  • Slow or Shallow Breathing.
  • Loss of Consciousness.
  • Coma.
  • Death.

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Abuse

The US federal government has classified butorphanol tartrate as a schedule IV medication, which means it carries a potential for abuse on the same level as Darvon or Darvocet. A person abuses drugs when he takes it without a prescription to relieve symptoms or to get high. Since butorphanol tartrate because available as a nasal spray, it has gained popularity among recreational drug abusers. An increasing number of drug abusers seek discarded veterinary butorphanol tartrate preparations because some of the active ingredient remains in the unit after administration and discarded veterinary dosing units may be more accessible than other forms of the drug.

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Withdrawal

Withdrawal is not necessarily an indication of criminal butorphanol tartrate abuse. You may experience symptoms of withdrawal after using high doses of butorphanol tartrate for a long time under the care of a physician. When you become dependent on a drug, your body needs the chemicals in that drug in order to feel normal and stable. You experience symptoms of withdrawal when the levels of those chemicals in your body suddenly drop. If you associate these unpleasant withdrawal symptoms with butorphanol tartrate, you may begin to crave butorphanol tartrate because you know taking the drug will relieve your symptoms.

Withdrawal symptoms include:

  • Agitation.
  • Anxiety.
  • Depression.
  • Hallucinations.
  • Mood Changes.
  • Weakness and Diarrhea.

Detox

Dependence on butorphanol tartrate is a complex medical condition that requires an equally multifaceted approach to recovery. The first phase in standard drug rehabilitation focuses on detoxifying the body and reducing withdrawal symptoms. Withdrawal symptoms are physically uncomfortable and potent withdrawal symptoms pose a significant obstacle to recovery. These symptoms typically last five or more days. Experiencing withdrawal symptoms is also demoralizing, impeding the progress a patient may make during the second phase of rehabilitation, which includes counseling. During standard rehabilitation, doctors and nurses administer medicines to reduce symptoms of withdrawal and detoxify the body.

Rapid detox offers patients a fast, effective and safe way to overcome withdrawal symptoms. Alongside the standard anti-withdrawal and detoxification drugs, specially trained physicians administer anesthetics and sedatives. Patients sleep through withdrawal and then awaken unaware of the unpleasant physical symptoms of withdrawal. Withdrawal symptoms last only a few hours with rapid detox, compare with days for standard treatment.

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Storage

Hospital staff is responsible for the storage of butorphanol tartrate IV and IM medications. You may be responsible for storing butorphanol tartrate in your home. Keep this medication at room temperature, between 59 and 86 degrees Fahrenheit. Protect from light and prevent freezing. Throw away all unused butorphanol tartrate.

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Miscellaneous information

Butorphanol tartrate is more effective for women than for men. Miscellaneous Information About Butorphanol Tartrate