Butorphanol medication

Opioids and derivatives (e.g., meperidine, butorphanol, oxycodone, hydromorphone) provide effective relief of intractable migraine but should be reserved for patients with moderate to severe infrequent headaches in whom conventional therapies are contraindicated or as rescue medication after failure to respond to conventional therapies. Opioid therapy should be closely supervised. 

Comments. The clearest lesson from the butorphanol experience is that when a drug is introduced to a new population, it is important to determine whether extant abuse-liability studies will generalize to that population. If not, then clinical trials should be designed to detect signs of abuse in that population, and careful postmarketing surveillance should occur. The goal is not to prevent patient access to necessary medications, but to ensure that providers and patients have adequate information about the risks of such medications. 

Pharmacokinetics and adverse effects of butorphanol administered by single intravenous injection or continuous intravenous infusion in horses. American Journal of Veterinary Research 62 183-189 Sharrock A G 1982 Reversai of drug-induced priapism in a gelding by medication. Australian Veterinary Journal 58 39-40... 

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]. 

The term opioids refers to these and other derivatives of naturally occurring opium (eg, morphine, heroin, codeine, and hydrocodone) as well as new, totally synthetic opiate anaiogs (eg, fentanyl, butorphanol, meperidine, and methadone Table 11-43). A wide variety of prescription medications contain opioids, often in combination with aspirin or acetaminophen. Dextromethorphan (see p 183) is an opioid derivative with potent antitussive but no analgesic or addictive properties. Tramadol (Ultram )... 

Butorphanol may produce respiratory depression, with other medications with significant CNS action and in patients with CNS or respiratory diseases. 

It is not known whether the effects of butorphanol are altered by concomitant medications that affect hepatic metabolism of drugs (erythromycin, theophylline, etc.), but physicians should be alert to the possibility that a smaller initial dose and longer intervals between doses may be needed. 

---