Butorphanol availability

For each drug, the prevalence of abuse was partly attributable to its absolute availability — for example, the over-the-counter status of dextromethorphan (DXM) or the expansion of fentanyl and butorphanol from inpatient to outpatient use. But the pattern of abuse for each drug was distinctive and probably could not have been predicted from the available experimental abuse-liability data. 

Table 8.3 shows a selective timeline of the evaluation, abuse, and regulation of DXM, a nonnarcotic cough suppressant with activity at sigma and PCP receptors. Unlike butorphanol and fentanyl, it has never been scheduled in the Controlled Substances Act, and it is available without a prescription in various over-the-counter formulations. 

The availability of new routes of administration have led to increased utility and decreased opioid adverse drug reaction risk. Epidural and intrathecal administration through spinal catheters produces adequate regional analgesia at relatively low total doses compared with intravenous or oral routes. As such, spinal administration can thus minimize somnolence, nausea, vomiting, and respiratory depression associated with these medications. Other alternative routes include intranasal administration of butorphanol, and rectal and transdermal administration of fentanyl [28]. Availability of such options provides not only a decreased risk of adverse reactions, but also more comfortable measures for patients who would otherwise require continued intravenous administration, or for those who are unable to receive oral medication [28,29]. 

Butorphanol tartrate (stadol) is better suited for the relief of acute than chronic pain. Because of its side effects on the heart, it is less useful than morphine or meperidine in patients with congestive heart failure or myocardial infarction. The usual dose is 1-4 mg of the tartrate given intramuscularly or 0.5-2 mg given intravenously every 3-4 hours. A nasal formulation (STADOLNS) is available and has proven to be effective. 

Opioid Agonist-Antagonist or Butorphanol (stadol) Nalbuphine (nubain) Partud Agonist (continued) Not available Not available 2 mg q3 h 10 mg q3 h Not available Not available 2 mg q3 h 10 mg q3 h Not available Not available Not recommended 0.1 mg/kg q3-4h... 

Generic Name butorphanol, butorphanol tartrate, butorphanol tartrate injection, USP, butorphanol tartrate nasal spray Trade/Proprietary Names Nasal Stadol Mora-dol and Beforal (the brand name Injectable Stadol is no longer available in the USA) Manufacturers Roxane Laboratories, 1809 Wilson Rd, Columbus, OH Barr Laboratories, 223 Quaker Road, Pomona, NY... 

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