Generic Name

Levallorphan Tartrate

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Classification

FDA Approved Indications

• Cough suppression

Mechanism of Action

Levallorphan Tartrate acts centrally on the cough center in the medulla to suppress cough reflex; it also has weak opioid activity, acting as a partial agonist or antagonist at opioid receptors, which modulates pain and cough reflexes.

Dosage and Administration

Adult: Typically 10-20 mg orally every 4-6 hours as needed, not to exceed 120 mg per day.

Pediatric: Use is generally limited; pediatric dosing should follow physician guidance, often lower, such as 5-10 mg every 4-6 hours as needed.

Geriatric: Careful dosing due to potential increased sensitivity; start at lower doses and titrate as needed.

Renal Impairment: Adjust dosing cautiously; monitor for accumulation of metabolites.

Hepatic Impairment: Use with caution; hepatic metabolism may be impaired, increasing risk of adverse effects.

Pharmacokinetics

Absorption: Well absorbed orally.

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

Metabolism: Metabolized in the liver, primarily via conjugation.

Excretion: Excreted mainly in urine as metabolites.

Half Life: Approximately 2-4 hours.

Contraindications

• Significant respiratory depression
• Use in acute asthma or varying respiratory conditions without adequate monitoring.
• Known hypersensitivity to levallorphan or opioids.

Precautions

• Use cautiously in patients with head trauma, increased intracranial pressure, or in those who are pregnant or breastfeeding. Newborns and children may be more sensitive to respiratory depressant effects.

Adverse Reactions - Common

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

Adverse Reactions - Serious

• Respiratory depression (Rare but serious)
• Hypersensitivity reactions (rash, pruritus) (Rare)
• Dependence or addiction with prolonged use (Rare)

Drug-Drug Interactions

• CNS depressants (sedatives, alcohol) enhancing sedation and respiratory depression.
• MAO inhibitors increasing the risk of respiratory depression and hypotension.

Drug-Food Interactions

• Avoid alcohol as it enhances CNS and respiratory depression.

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Do not operate heavy machinery or drive until response is known.
• Avoid alcohol and other CNS depressants.
• Report signs of difficulty breathing, excessive drowsiness, or rash.
• Take as prescribed; do not increase dose without consulting healthcare provider.

Special Considerations

Black Box Warnings:

• Potential for respiratory depression, especially in children and when combined with other CNS depressants.

Genetic Factors: Genetic variations may affect response to opioid medications.

Lab Test Interference: May interfere with some laboratory tests measuring liver function or serum calcium.

Overdose Management

Signs/Symptoms: Respiratory depression, sedation, pinpoint pupils, hypotension.

Treatment: Administer opioid antagonist (e.g., naloxone), provide supportive respiratory care, and maintain airway, monitor vital signs, and provide symptomatic treatment as needed.

Storage and Handling

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

Stability: Stable under recommended storage conditions.