Butorphanol

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Drugs Dictionary: Butorphanol

Butorphanol

Trade Name

Stadol (historical brand name); generic butorphanol tartrate

Classification

Opioid analgesic; mixed opioid agonist-antagonist; Schedule IV controlled substance

Dosage/Route

* Dosage:
- – Nasal spray: 1 mg/spray (10 mg/mL)
- – Injection: 1 mg/mL, 2 mg/mL vials
* Route: Intranasal (IN), intravenous (IV), intramuscular (IM)

Usual Dosage

* Pain (Adults):
- – IN: 1 mg (1 spray) every 3-4 hours PRN; may give 2 mg (1 spray each nostril) if needed, max 4 mg/dose
- – IV: 0.5-2 mg every 3-4 hours PRN
- – IM: 1-4 mg every 3-4 hours PRN; max 4 mg/dose
* Adjust for opioid tolerance; not for chronic pain

Mechanism of Action

Acts as a kappa opioid receptor agonist and mu opioid receptor partial agonist/antagonist. Provides analgesia (kappa) with a ceiling effect on respiratory depression (mu antagonism); less euphoria/abuse potential than pure mu agonists (e.g., morphine)

Side Effects & Adverse Effects

* Side Effects: Drowsiness, dizziness, nausea, headache, nasal irritation (IN).
* Adverse Effects:
- – Respiratory depression (less severe, but still possible).
- – Hypotension, confusion.
- – Withdrawal in opioid-dependent patients (antagonist effect).
- – Dependence (Schedule IV, lower risk than Schedule II opioids)

Nursing Management (Implications & Teachings)

* Implications:
- – Monitor respiratory rate, BP, sedation (esp. IV; baseline and q15-30 min initially)
- – Assess pain level pre/post-dose; watch for withdrawal (sweating, agitation) in opioid users
- – IV: Give slow push over 3-5 min; IN: Alternate nostrils if repeat dose
- – Avoid in opioid-dependent patients unless transitioning
* Teachings:
- – Use as prescribed; don’t increase dose (ceiling effect)
- – Report slow breathing, confusion, or nasal burning
- – Avoid alcohol/driving (CNS depression)
- – Store securely (controlled substance); prime nasal spray if new