Home Drug Guide Levorphanol Tartrate

Drug Guide

Generic Name

Levorphanol Tartrate

Brand Names Levo-dromoran

Classification

Therapeutic: Analgesic, Opioid

Pharmacological: Mu-opioid receptor agonist and NMDA receptor antagonist

FDA Approved Indications

  • Moderate to severe pain management

Mechanism of Action

Levorphanol binds to mu-opioid receptors in the central nervous system, producing analgesia. It also antagonizes NMDA receptors, reducing opioid tolerance and modulation of pain pathways.

Dosage and Administration

Adult: Initial dose of 1-2 mg every 6-8 hours as needed; doses may be titrated based on response and tolerability.

Pediatric: Not established; use in pediatric patients is generally not recommended due to lack of safety data.

Geriatric: Start with lower doses due to increased sensitivity and potential renal/hepatic impairment; close monitoring required.

Renal Impairment: Use with caution; dosage adjustment may be necessary.

Hepatic Impairment: Use with caution; monitor for increased effects.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed throughout body tissues.

Metabolism: Metabolized in the liver; undergoes minimal hepatic biotransformation.

Excretion: Excreted mainly via the kidneys.

Half Life: Approximately 5-6 hours.

Contraindications

  • History of hypersensitivity to levorphanol or other opioids.
  • Respiratory depression.
  • Acute or severe bronchial asthma.

Precautions

  • Use with caution in patients with head injury, increased intracranial pressure, or IOP.
  • Potential for dependence, abuse, and respiratory depression.

Adverse Reactions - Common

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

Adverse Reactions - Serious

  • Respiratory depression (Serious)
  • Adrenal insufficiency (long-term use) (Serious)
  • Allergic reactions including anaphylaxis (Serious)

Drug-Drug Interactions

  • Benzodiazepines, other CNS depressants (additive effects)
  • MAO inhibitors (risk of severe respiratory depression)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

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

Diagnoses:

  • Risk of respiratory depression
  • Ineffective airway clearance

Implementation: Administer orally with food to minimize GI upset, monitor patient response and vital signs closely, especially after initial doses.

Evaluation: Assess pain relief, monitor for adverse effects, especially respiratory depression and sedation.

Patient/Family Teaching

  • Do not operate heavy machinery or drive until effects are known.
  • Avoid alcohol and CNS depressants.
  • Report signs of respiratory depression, excessive sedation, or allergic reactions.
  • Adhere to prescribed dosing schedule; do not increase dose without medical advice.

Special Considerations

Black Box Warnings:

  • Respiratory depression, which can be fatal, especially when starting therapy or increasing dosage.
  • Addiction, abuse, and misuse potential.
  • Neonatal opioid withdrawal syndrome if used near delivery.

Genetic Factors: Genetic variations may affect opioid metabolism and response.

Lab Test Interference: May alter hepatic function tests; monitor as indicated.

Overdose Management

Signs/Symptoms: Respiratory depression, somnolence, muscle flaccidity, cold/clammy skin, pin-point pupils.

Treatment: Supportive measures including airway management, ventilation support, and opioid antagonist (naloxone) administration.

Storage and Handling

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

Stability: Stable under recommended storage conditions.

🛡️ 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.