Classifications: analgesic; narcotic (opiate) agonist;
Therapeutic: narcotic analgesic

Prototype: Morphine sulfate
Pregnancy Category: B; D with long-time use or high doses
Controlled Substance: Schedule II


2 mg tablets; 2 mg/mL injection


A potent synthetic morphine derivative with agonist activity only. Reported to cause less nausea, vomiting, and constipation than equivalent doses of morphine but may produce more sedation, smooth-muscle stimulation, and respiratory depression.

Therapeutic Effect

More potent as an analgesic and has somewhat longer duration of action than morphine.


To relieve moderate to severe pain. Also preoperatively to allay apprehension.


Hypersensitivity to levorphanol; labor and delivery, pregnancy (category B, and D with long time use or high doses); lactation.

Cautious Use

Patients with impaired respiratory reserve, or depressed respirations from another cause (e.g., severe infection, obstructive respiratory conditions, chronic bronchial asthma). Patients with head injury or increased intracranial pressure; acute MI, cardiac dysfunction; liver disease, biliary surgery, alcohol or delirium tremens; liver or kidney dysfunction, hypothyroidism, Addison's disease, toxic psychosis, prostatic hypertrophy, or urethral stricture; concurrent use with CNS depressant drugs; older adults, other vulnerable populations; renal impairment.

Route & Dosage

Moderate to Severe Pain
Adult: PO 1 mg q3–6h prn IV 1 mg q3–6h prn IM/SC 1–2 mg q6–8h


  • Give in the smallest effective dose to minimize the possibility of tolerance and physical dependence.
  • Store tablets at 15°–30° C (59°–86° F) unless otherwise directed. Store in tightly covered, light-resistant containers.

INCOMPATIBILITIES Solution/additive: Aminophylline, ammonium chloride, amobarbital, chlorothiazide, heparin, methicillin, nitrofurantoin, novobiocin, pentobarbital, perphenazine, phenobarbital, phenytoin, secobarbital, sodium bicarbonate, sodium iodide, sulfadiazine, sulfisoxazole diethanolamine, thiopental.

Adverse Effects (≥1%)

CNS: Euphoria, sedation, drowsiness, nervousness, confusion. CV: Hypotension, arrythmias. GI: Nausea, vomiting, dry mouth, cramps, constipation. Urogenital: Urinary frequency, urinary retention, sedation. Special Senses: Blurred vision. Respiratory: Respiratory depression. Body as a Whole: Physical dependence.


Drug: Alcohol and other cns depressants compound sedation and CNS depression. Herbal: St. John's wort may increase sedation.


Peak: 60–90 min (PO); 15–30 min (IM). Duration: 6–8 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 11–16 h.

Nursing Implications

Assessment & Drug Effects

  • Assess degree of pain relief. Drug is most effective when peaks and valleys of pain relief are avoided.
  • Monitor bowel function.
  • Monitor ambulation, especially in older adult patients.

Patient & Family Education

  • Do not drive or engage in other potentially hazardous activities.
  • Avoid alcohol and other CNS depressants unless approved by physician.
  • Note: Ambulation may increase frequency of nausea and vomiting.
  • Increase fluid and fiber intake to offset constipating effects of the drug.

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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