Nurses Compass
Drug Guide
Levorphanol Tartrate
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/ADrug-Herb Interactions
N/ANursing 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.