Butorphanol (byoo-TOR-fa-nole) is a narcotic analgesic (pain medicine) that is sprayed into the nose. It is used to relieve moderate or severe pain. It is also used to relieve pain that occurs after an operation.

Narcotic analgesics act in the central nervous system (CNS) to relieve pain. Some of their side effects are also caused by actions in the CNS.

If a narcotic is used for a long time, it may become habit-forming (causing mental or physical dependence). Physical dependence may lead to withdrawal side effects when you stop taking the medicine.

This medicine is available only with your doctor's or dentist's prescription, in the following dosage form:

Nasal
• Nasal solution (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For butorphanol, the following should be considered:

Allergies? Tell your doctor if you have ever had any unusual or allergic reaction to butorphanol or any other narcotic analgesic. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy? Nasal butorphanol has not been studied in pregnant women. However, studies in animals have shown that butorphanol causes a decreased pregnancy rate and an increase in stillbirths. Before taking this medicine make sure your doctor knows if you are pregnant or if you may become pregnant.

Too much use of butorphanol during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth.

Breast-feeding? Although butorphanol may pass into the breast milk, it is not expected to cause problems in nursing babies.

Children? Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of butorphanol in children with use in other age groups.

Older adults? Elderly people are especially sensitive to the effects of butorphanol. This may increase the chance of side effects, especially dizziness, during treatment. Studies in older adults show that butorphanol stays in the body for a longer time than it does in younger adults. Your doctor will consider this when deciding on your dose.

Other medicines? Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking butorphanol it is especially important that your health care professional know if you are taking any of the following:

• Central nervous system (CNS) depressants (medicines that make you drowsy or less alert) or
• Tricyclic antidepressants (medicines for depression) (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])?The chance of side effects may be increased

• Narcotic pain medicine, other? Withdrawal symptoms may occur if a narcotic you are dependent on is replaced by butorphanol.

Other medical problems? The presence of other medical problems may affect the use of butorphanol. Make sure you tell your doctor if you have any other medical problems, especially:

• CNS disease affecting breathing or
• Emphysema, asthma, or other chronic lung disease or
• Head injury? Some of the side effects of butorphanol can be dangerous if you have any of these conditions

• Drug dependence, especially narcotic abuse, or history of, or
• Emotional problems? The chance of side effects may be increased; also, withdrawal symptoms may occur if a narcotic you are dependent on is replaced by butorphanol

• Heart disease or
• Kidney disease or
• Liver disease? The chance of side effects may be increased