Home Drug Guide Butorphanol Tartrate

Drug Guide

Generic Name

Butorphanol Tartrate

Brand Names Stadol Preservative Free, Stadol, Butorphanol Tartrate Preservative Free

Classification

Therapeutic: Opioid analgesic, mixed agonist-antagonist

Pharmacological: Kappa-opioid receptor agonist and partial-mu-opioid receptor antagonist

FDA Approved Indications

  • Management of moderate to severe pain

Mechanism of Action

Butorphanol works by activating kappa-opioid receptors and partially blocking mu-opioid receptors, providing analgesia with potentially fewer side effects related to mu-opioid receptor activation.

Dosage and Administration

Adult: Typically 1-4 mg every 3-4 hours as needed, not exceeding 8 mg per dose or 24 mg per day.

Pediatric: Use is not established; consult specific pediatric guidelines.

Geriatric: Use with caution; start at lower end of dosing range.

Renal Impairment: Adjust dose cautiously; no specific guidelines, monitor for increased effects.

Hepatic Impairment: Use with caution; dosing adjustments may be necessary. Consider lower doses.

Pharmacokinetics

Absorption: Rapidly absorbed via intranasal, IM, IV routes.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized in the liver via CYP3A4 enzymes.

Excretion: Excreted mainly in urine, small amount in feces.

Half Life: Approximately 2-3 hours.

Contraindications

  • Hypersensitivity to butorphanol or other opioids.
  • Acute respiratory depression.
  • Shock.

Precautions

  • Use with caution in patients with a history of substance abuse, head injury, increased intracranial pressure, or hepatic impairment. Not recommended in obstetrics during labor due to potential neonatal respiratory depression.

Adverse Reactions - Common

  • Dizziness (Common)
  • Nausea (Common)
  • Drowsiness (Common)

Adverse Reactions - Serious

  • Respiratory depression (Uncommon but serious)
  • Hypotension (Uncommon)
  • Cardiovascular collapse (Rare)

Drug-Drug Interactions

  • CNS depressants (e.g., alcohol, benzodiazepines) increasing sedation risk.
  • Other opioids may enhance effects or respiratory depression.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, level of consciousness, and pain relief.

Diagnoses:

  • Risk for respiratory depression
  • Ineffective airway clearance
  • Risk for falls due to dizziness or sedation

Implementation: Administer IV, IM, or intranasal as prescribed. Monitor vital signs closely.

Evaluation: Assess pain relief, respiratory status, and for adverse effects.

Patient/Family Teaching

  • Do not operate heavy machinery or drive.
  • Avoid alcohol and sedatives.
  • Report excessive drowsiness, confusion, difficulty breathing.

Special Considerations

Black Box Warnings:

  • Risks of addiction, abuse, and misuse.

Genetic Factors: No specific pharmacogenetic considerations.

Lab Test Interference: May alter some laboratory test results, such as for liver function or urinalysis.

Overdose Management

Signs/Symptoms: Sedation, respiratory depression, pinpoint pupils.

Treatment: Administer naloxone for respiratory depression. Supportive care including airway management and mechanical ventilation if necessary.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable until the expiration date on the package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.