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butorphanol nasal
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; proper dosing and titration essential to decr. resp. depression risk
Addiction, Abuse, and Misuse
opioid agonist Schedule IV controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, esp. in children, can result in fatal butorphanol overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. butorphanol levels and may cause potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer
Adult Dosing .
Dosage forms: SPRAY: 1 mg per actuation
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental exposure
pain, mod-severe
- [1-2 mg intranasally q3-4h prn]
- Start: 1 mg intranasally x1, may repeat in 60-90min, then q3-4h prn; Info: use lowest effective dose, shortest effective tx duration; for elderly pts, start 1 mg intranasally x1, may repeat in 90-120min, then q6h prn; for recumbent pts w/ severe pain, may give 2 mg intranasally q3-4h prn; give 2 mg dose as 1 actuation in each nostril; taper total daily dose by no more than 10-25% q2-4wk to D/C if long-term use
renal dosing
- [adjust dose amount]
- renal impairment: start 1 mg intranasally x1, may repeat in 90-120min, then give q6h prn
- HD/PD: not defined
hepatic dosing
- [adjust dose frequency]
- hepatic impairment: start 1 mg intranasally x1, may repeat in 90-120min, then give q6h prn
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.