butorphanol tartrate

(redirected from Stadol NS)

butorphanol tartrate

APO-Butorphanol (CA), PMS-Butorphanol (CA), Stadol

Pharmacologic class: Opioid agonist-antagonist

Therapeutic class: Opioid analgesic

Controlled substance schedule IV Pregnancy risk category C

Action

Alters perception of and emotional response to pain by binding with opioid receptors in brain, causing CNS depression. Also exerts antagonistic activity at opioid receptors, which reduces risk of toxicity, drug dependence, and respiratory depression.

Availability

Injection: 1 mg/ml, 2 mg/ml

Nasal spray: 10 mg/ml

Indications and dosages

Moderate to severe pain

Adults: 1 to 4 mg I.M. q 3 to 4 hours as needed, not to exceed 4 mg/dose. Or 0.5 to 2 mg I.V. q 3 to 4 hours as needed. With nasal spray, 1 mg (one spray in one nostril) q 3 to 4 hours, repeated in 60 to 90 minutes if needed.

Labor pains

Adults: 1 to 2 mg I.V. or I.M., repeated after 4 hours as needed

Preoperative anesthesia

Adults: 2 mg I.M. 60 to 90 minutes before surgery

Balanced anesthesia

Adults: 2 mg I.V. shortly before anesthesia induction, or 0.5 to 1 mg I.V. in increments during anesthesia

Dosage adjustment

• Renal or hepatic impairment

• Elderly patients

Off-label uses

• Headache

• Symptomatic relief of ureteral colic

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

• head injury, ventricular dysfunction, coronary insufficiency, respiratory disease, renal or hepatic dysfunction

• history of drug abuse.

Administration

• Make sure solution is clear and free of particulates before giving.

• When using nasal spray, insert tip of the sprayer about ¼″ into nostril, point tip backwards, and administer one spray.

• Be aware that I.V. route is preferred for severe pain.

Know that drug may cause infant respiratory distress in neonate of pregnant patient, especially if given within 2 hours of delivery.

Adverse reactions

CNS: drowsiness, sedation, dizziness, tremor, irritability, syncope, stimulation

CV: hypertension, hypotension, palpitations, bradycardia, tachycardia, extrasystole, arrhythmias

EENT: blurred vision, nasal congestion or dryness, dry or sore throat

GI: nausea, vomiting, constipation, epigastric distress, dry mouth, GI obstruction

GU: urinary retention or hesitancy, dysuria, early menses, decreased libido, erectile dysfunction

Hematologic: hemolytic anemia, hypoplastic anemia, thrombocytopenia, agranulocytosis, leukopenia, pancytopenia

Respiratory: thickened bronchial secretions, chest tightness, wheezing

Skin: urticaria, rash, diaphoresis

Other: increased or decreased appetite, weight gain, local stinging, anaphylactic shock, hypersensitivity reaction (with I.V. use)

Interactions

Drug-drug. CNS depressants: additive CNS effects

Drugs-herbs. Kava, St. John's wort, valerian: increased CNS depression

Drug-behaviors. Alcohol use: additive CNS effects

Patient monitoring

• Monitor respiratory status closely, especially after I.V. administration.

• Watch for signs and symptoms of withdrawal in long-term use and in opioid-dependent patients.

• Assess elderly patient closely for sensitivity to drug.

Patient teaching

• Teach patient how to use nasal spray properly.

• Emphasize importance of using drug exactly as prescribed.

• Caution patient that drug may be habit-forming.

• Advise 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 and behaviors mentioned above.

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McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved
References in periodicals archive ?
Other recent FDA approvals include: butophanol tartrate nasal spray, 10 mg./ml., a generic equivalent to Bristol-Myers Squibb Co.'s analgesic Stadol NS; the anticancer drug paclitaxel injection in three dosage strengths; lovastatin tablets (the generic equivalent of Merck & Co.'s cholesterol-lowering agent Mevacor) in two dosage strengths; famotidine tablets (a generic version of Merck's ulcer medication Pepcid); fluvoxamine maleate tablets (the generic equivalent of Solvay Pharmaceuticals' Luvox tablets for treating obsessive and compulsive disorders) in 25-, 50- and 100-mg.
45); maximum two injections per 24 hours at least 1 hour apart 1-mg spray in each nostril (2 mg total, Migranal); repeat in 15 minutes if needed; maximum 4 mg/24 hr butorphanol nasal 1-mg spray in one nostril; repeat as spray needed, waiting at least 60 minutes (Stadol NS) between doses PREVENTIVE THERAPY prednisone 60 mg/day to start, tapering by 10 mg every other day for 5-10 days verapamil 80 mg t.i.d.
Look for strong sales of Taxol and Paraplatin, anticancer drugs, and Pravachol, a cholesterol-lowering agent, as well as of such new entries as Stadol NS, an analgesic, and Glucophage, a diabetes medication.