How does this medication work? What will it do for me?

Butorphonal belongs to the family of medications known as narcotic analgesics (pain-relievers). It is used for the relief of moderate-to-severe acute pain. It works by affecting the pain centers of the central nervous system (the nerves that carry pain signals back and forth to the brain). Butorphanol nasal spray works within 15 to 30 minutes to relieve pain.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

This medication is available as a 10 mg/mL nasal spray.

How should I use this medication?

The dose depends on your response to the medication. The usual recommended adult dose for starting nasal therapy is one spray in one nostril (1 mg). A repeat dose may be allowed if there is inadequate pain relief within 60 to 90 minutes of the initial dose.

This dosing sequence can be repeated every 3 to 4 hours as needed for pain relief. The dose may be increased as directed by your doctor, but doses of more than 16 mg daily are not normally recommended. The effectiveness of butorphanol for periods longer than 3 days has not been established.

For people who experience more severe pain, their doctor may prescribe an initial dose of one spray in each nostril. If this is the case, ensure there is a place for you to lie down, as drowsiness or dizziness may occur. The next dose should not be used for 3 or 4 hours. Seniors and those with kidney or liver damage may require different dosing as prescribed by their doctor.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

This medication may be habit-forming if taken for long periods of time. Do not stop taking this medication without talking with your doctor. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shakiness, nausea, tremors, diarrhea, or hallucinations. If you plan on stopping the medication, your doctor may want you to reduce the dose gradually to reduce the severity of withdrawal effects.

It is important to use this medication exactly as prescribed by your doctor. Do not take more of this medication than your doctor has recommended.

Store this medication at room temperature, with the protective clip and dust cover on. Keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use butorphanol nasal spray if you are allergic to butorphanol or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people using this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • appetite changes (increase or decrease)
  • change in sense of taste
  • chills
  • dizziness
  • drowsiness
  • dry mouth
  • feeling hot
  • headache
  • irritation inside nose
  • itchiness
  • nasal congestion
  • nausea
  • spinning sensation
  • thirst
  • weakness (severe)
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxious feeling
  • behaviour changes
  • blurred vision
  • confusion
  • decreased coordination
  • false sense of well-being
  • floating feeling
  • hearing loss
  • nervousness, sometimes with restlessness
  • nosebleeds
  • ringing or buzzing in ears
  • signs of allergy (e.g., skin rash or hives)
  • signs of breathing problems (e.g., shortness of breath, wheezing, irregular or troubled breathing)
  • sweating or clammy feeling
  • tingling, burning, prickling or pain in the hands or feet

Stop taking the medication and seek medical attention immediately if any of the following occur:

  • convulsions (seizures)
  • signs of too much butorphanol; overdose:
    • cold, clammy skin
    • low blood pressure
    • pinpoint pupils of eyes
    • severe drowsiness, weakness
    • severe nervousness or restlessness
    • slow heartbeat
  • signs of a serious allergic reaction:
    • abdominal cramps
    • difficulty breathing
    • nausea and vomiting
    • swelling of the face and throat
  • slow or troubled breathing

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Breathing: Butorphanol can suppress breathing. If you are at risk for breathing difficulties, such as asthma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dependence and withdrawal: Physical dependence, psychological dependence, and abuse have occurred with the use of butorphanol. People with a history of past or current substance use problems may be at greater risk of developing abuse or addiction while taking this medication.

Abuse is not a problem with people who require this medication for pain relief. If you suddenly stop taking this medication, you may experience withdrawal symptoms such as anxiety, agitation, diarrhea, and hallucinations. If you have been taking this medication for a while, it should be stopped gradually as directed by your doctor.

Dizziness: Butorphanol can cause severe dizziness, especially when rising from a sitting or lying position. This is more likely to occur within the first hour of butorphanol being used or when other medications with similar side effects are being taken. People taking medications that can cause dizziness should rise slowly from sitting or lying down to reduce the possibility of severe dizziness or fainting.

Drowsiness/reduced alertness: This medication may cause drowsiness or dizziness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Head injury: If you have had a head injury or have increased pressure in the head, you may have a higher risk of experiencing side effects (breathing problems) or worsening of your condition while taking this medication. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart conditions: Butorphanol increases the work the heart must do to maintain circulation throughout the body. If you have congestive heart failure or have recently had a heart attack, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Decreased kidney function can cause a buildup of butorphanol in the body, resulting in more severe side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Decreased liver function can cause a buildup of butorphanol in the body, resulting in more severe side effects. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Narcotic dependence: People who are physically dependent on narcotics should not take butorphanol, as they may experience withdrawal symptoms. Such people should have an adequate period of withdrawal from narcotic medications prior to starting butorphanol therapy.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are using butorphanol, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication have not been established for children and adolescents under 18 years of age.

Seniors: Seniors may be more sensitive to the side effects of butorphanol, particularly dizziness.

What other drugs could interact with this medication?

There may be an interaction between butorphanol and any of the following:

  • alcohol
  • amphetamines
  • anaesthetics
  • antihistamines (e.g., cetirizine, dimenhydrinate, diphenhydramine, hydroxyzine)
  • antipsychotic medications (e.g., olanzepine, quetiapine, risperidone)
  • baclofen
  • barbiturates (e.g., phenobarbital, secobarbital)
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • bupropion
  • buspirone
  • cyclobenzaprine
  • desmopressin
  • dextroamphetamine
  • diphenoxylate
  • entacapone
  • gabapentin
  • MAO inhibitors (e.g., moclobemide, phenelzine, tranylcypromine)
  • naloxone
  • octreotide
  • other narcotic medications (e.g., codeine, fentanyl, morphine, oxycodone)
  • pramipexole
  • pregabalin
  • ropinirole
  • scopolamine
  • seizure medications (e.g., carbamazepine, lamotrigine, phenytoin, primidone)
  • selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram)
  • thiazide diuretics (e.g., hydrochlorothiazide, indapamide)
  • thiopental
  • tapentadol
  • tramadol
  • tricyclic antidepressants (e.g., amitriptyline, desipramine, imipramine)
  • zolpidem
  • zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.