levorphanol tartrate

levorphanol tartrate

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

Tablets: 2 mg

Indications and dosages

Moderate to severe pain

Adults: 2 mg P.O. q 6 to 8 hours p.r.n., provided patient is assessed for hypoventilation and excessive sedation. If necessary, may increase dosage to up to 3 mg q 6 to 8 hours, after adequate evaluation of patient response. Higher doses may be appropriate in opioid-tolerant patients. Adjust dosage according to patient's severity of pain, age, weight, physical status, underlying diseases, and use of concomitant medications. Total oral daily doses of more than 6 to 12 mg in 24 hours are generally not recommended as starting doses in nonopioid-tolerant patients.

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.

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: 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

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.
• Advise patient to avoid alcohol while taking this drug.
• 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.

levorphanol tartrate

(lĕ-vôr′fə-nôl′)
n.
A synthetic opioid used primarily as an analgesic, with action similar to morphine.

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.

levorphanol tartrate

(lēv-or′fă-nŏl)
A synthetic analgesic that acts similarly to morphine.
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References in periodicals archive ?
Levorphanol Tartrate Tablets USP CII 2mg, Manufactured by
announced today the availability of Levorphanol Tartrate Tablets USP CII 2mg in bottles of 100.
Patients and physicians unable to obtain Levo-Dromoran(R)* will now have an alternative source for Levorphanol Tartrate Tablets USP CII 2mg.
Levorphanol tartrate tablets are indicated for the management of pain where an opioid analgesic is appropriate.