BUTORPHANOL TARTRATE

BUTORPHANOL TARTRATE
(byoo-tor'fa-nole)
Stadol, Stadol NS
Classifications: analgesic; narcotic (opiate) agonist-antagonist;
Therapeutic: narcotic analgesic

Prototype: Pentazocine
Pregnancy Category: C
Controlled Substance: Schedule IV

Availability

1 mg/mL, 2 mg/mL injection; 10 mg/mL spray

Action

Synthetic, centrally acting analgesic with mixed narcotic agonist and antagonist actions. Acts as agonist on one type of opioid receptor and as a competitive antagonist at others. Site of analgesic action believed to be subcortical, possibly in the limbic system. Respiratory depression does not increase appreciably with higher doses, as it does with morphine, but duration of action increases.

Therapeutic Effect

Narcotic analgesic that relieves moderate to severe pain with apparently low potential for physical dependence.

Uses

Relief of moderate to severe pain, preoperative or preanesthetic sedation and analgesia, obstetrical analgesia during labor, cancer pain, renal colic, burns.

Unlabeled Uses

Musculoskeletal and post-episiotomy pain.

Contraindications

Narcotic-dependent patients; opiate agonist hypersensitivity; pregnancy and prior to labor (category C). Safety in children <18 y is not established.

Cautious Use

History of drug abuse or dependence; emotionally unstable individuals; head injury, increased intracranial pressure; acute MI, ventricular dysfunction, coronary insufficiency, hypertension; patients undergoing biliary tract surgery; respiratory depression, bronchial asthma, obstructive respiratory disease; and renal or hepatic dysfunction.

Route & Dosage

Pain Relief
Adult: IM 1–4 mg q3–4h as needed (max: 4 mg/dose) IV 0.5–2 mg q3–4h as needed
Geriatric: IM/IV 0.25–1 mg q6–8h Intranasal 1 mg (1 spray) in one nostril, may repeat in 90 s, then may repeat these 2 doses q3–4h prn

Adjunct to Balanced Anesthesia
Adult: IV 2 mg before induction or 0.5–1 mg in increments during anesthesia

Labor
Adult: IV/IM 1–2 mg may repeat in 4 h

Renal Impairment
For GFR <10 mL/min, use 50% of dose.

Hepatic Impairment
Use half normal dose and at least 6 h interval.

Administration

Intranasal
  • Give 1 spray into one nostril only. One spray provides a 1 mg dose.
Intramuscular
  • Do not give more than 4 mg in a single IM dose.
  • Give preoperative IM injection 60–90 min before surgery.
Intravenous

PREPARE: Direct: Give undiluted.  

ADMINISTER: Direct: Give at a rate of 2 mg over 3–5 min.  

INCOMPATIBILITIES Y-site: Amphotericin B cholesteryl, lansoprazole, midazolam.

  • Store at 15°–30° C (59°–86° F) unless otherwise directed. Protect from light.

Adverse Effects (≥1%)

CNS: Drowsiness, sedation, headache, vertigo, dizziness, floating feeling, weakness, lethargy, confusion, light-headedness, insomnia, nervousness, respiratory depression. CV: Palpitation, bradycardia. GI: Nausea. Skin: Clammy skin, tingling sensation, flushing and warmth, cyanosis of extremities, diaphoresis, sensitivity to cold, urticaria, pruritus. Genitourinary: Difficulty in urinating, biliary spasm.

Interactions

Drug: Alcohol and other cns depressants augment CNS and respiratory depression.

Pharmacokinetics

Onset: 10–30 min IM; 1 min IV. Peak: 0.5–1 h IM; 4–5 min IV. Duration: 3–4 h IM; 2–4 h IV. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver in inactive metabolites. Elimination: Primarily in urine. Half-Life: 3–4 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for respiratory depression. Do not administer drug if respiratory rate is <12 breaths/min.
  • Monitor vital signs. Report marked changes in BP or bradycardia.
  • Note: If used during labor or delivery, observe neonate for signs of respiratory depression.
  • Note: Drug can induce acute withdrawal symptoms in opiate-dependent patients.
  • Schedule gradual withdrawal following chronic administration. Abrupt withdrawal may produce vomiting, loss of appetite, restlessness, abdominal cramps, increase in BP and temperature, mydriasis, faintness. Withdrawal symptoms peak 48 h after discontinuation of drug.

Patient & Family Education

  • Lie down to control drug-induced nausea.
  • Do not take alcohol or other CNS depressants with this drug without consulting physician because of possible additive effects.
  • Do not drive or engage in other potentially hazardous activities until response to drug is known.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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