levorphanol tartrate

lev·or·pha·nol tartrate (l-vôrf-nôl)

n.

An addictive drug used primarily as an analgesic with action similar to morphine.

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levorphanol tartrate

[lē′vôrfā′nol]

an opioid analgesic.

indications It is prescribed for the treatment of pain and preoperative analgesia.

contraindications Alcoholism, asthma, increased intracranial pressure, respiratory depression, anoxia, or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse effects are drug dependence, orthostatic hypotension, cardiac arrhythmia, and retention of urine.

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levorphanol tartrate Warning - High-alert drug!

Levo-Dromoran

Pharmacologic class: Synthetic opioid agonist

Therapeutic class: Opioid analgesic

Controlled substance schedule II

Pregnancy risk category C

Action

Inhibits adenylate cyclase, which regulates release of pain neurotransmitters (acetylcholine, dopamine, substance P, and gamma-aminobutyric acid). Also stimulates mu and kappa opioid receptors, altering perception of and emotional response to pain.

Availability

Injection: 2 mg/ml

Tablets: 2 mg

⊘Indications and dosages

➣ Pain

Adults: 2 mg P.O. q 3 to 6 hours p.r.n., provided patient is assessed for hypoventilation and excessive sedation. Range is 8 to 16 mg over 24 hours in nontolerant patients (daily dosages above 16 mg aren't recommended). Alternatively, 2 mg subcutaneously or I.V.; may increase to 3 mg p.r.n. For cancer patients and in other situations in which long-term opioid therapy is indicated, daily dosage is approximately one-twelfth of daily oral morphine dosage; however, therapy should be individualized.

➣ Preoperative analgesia

Adults: 1 to 2 mg subcutaneously 90 minutes before surgery

Dosage adjustment

• Hepatic or renal insufficiency
• Elderly patients

Contraindications

• Hypersensitivity to drug or other opioid agonists
• Bronchial asthma
• Increased intracranial pressure
• Respiratory depression
• Acute alcoholism

Precautions

Use cautiously in:
• renal or hepatic dysfunction, chronic obstructive pulmonary disease, acute abdominal conditions, cardiovascular disease, seizure disorders, cerebral arteriosclerosis, Addison's disease, prostatic hypertrophy, toxic psychosis
• pregnant or breastfeeding patients
• children.

Administration

☞ Make sure resuscitation equipment is available before starting therapy.
• Give I.V. injection slowly, administering each 2 mg over at least 4 to 5 minutes. Monitor patient response.
• Know that I.V. route is preferred in emergencies only.
• After parenteral administration, place patient in supine position with legs elevated to minimize adverse reactions.
• Be aware that 2 mg of levorphanol tartrate is analgesically equivalent to 10 to 15 mg of morphine and 100 mg of meperidine.

Route	Onset	Peak	Duration
P.O.	10-60 min	90-120 min	4-5 hr
I.V.	Unknown	20 min	4-5 hr
I.M.	Unknown	60 min	4-5 hr
Subcut.	Unknown	60-90 min	4-5 hr

Adverse reactions

CNS: personality disorders, nervousness, insomnia, hypokinesia, dyskinesia, drowsiness, light-headedness, dizziness, depression, delusions, confusion, amnesia, sedation, euphoria, delirium, mood changes, coma, seizures

CV: palpitations, hypotension, tachycardia, bradycardia, shock, peripheral circulatory collapse, cardiac arrest

EENT: diplopia, abnormal vision

GI: nausea, vomiting, constipation, abdominal pain, dyspepsia, increased colonic motility (in patients with chronic ulcerative colitis), dry mouth

GU: dysuria, urinary retention or hesitancy, ureteral or vesicle sphincter spasms, decreased libido, oliguria

Hepatic: biliary tract spasms, hepatic failure

Respiratory: suppressed cough reflex, hyperventilation, periodic apnea

Skin: urticaria, rash, pruritus, cyanosis, facial flushing

Other: injection site pain, redness, or swelling; physical or psychological drug dependence

Interactions

Drug-drug. Alfentanil, fentanyl, sufentanil, other CNS depressants: increased CNS and respiratory depression, increased risk of hypotension

Anticholinergics: increased risk of severe constipation

Antidiarrheals (such as atropine, difenoxin, kaolin, loperamide), antihypertensives: increased risk of hypotension

Buprenorphine, naloxone, naltrexone: decreased levorphanol efficacy

Metoclopramide: antagonism of metoclopramide effects

Neuromuscular blockers: increased risk of prolonged CNS and respiratory depression

Drug-diagnostic tests. Amylase, lipase: increased levels

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Check vital signs and respiratory status, and monitor ECG carefully.
• Evaluate fluid intake and output.
• Assess neurologic status. Institute safety precautions as needed to prevent injury.
• Watch for signs and symptoms of depression.
• Monitor liver and kidney function tests.

Patient teaching

• With parenteral use, explain need for continuous vital sign and ECG monitoring.
• To minimize adverse effects, instruct patient to lie supine after parenteral administration, if possible.
☞ Instruct patient or caregiver to report adverse reactions immediately.
• Tell patient or caregiver to use safety measures as needed to prevent injury and to report significant problems.
• Instruct patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.