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.