Vomiting butorphanol

Intranasal butorphanol may provide an alternative to frequent office or emergency department visits for injectable migraine therapies. Onset of analgesia occurs within 15 minutes of administration. Adverse effects include dizziness, nausea, vomiting, drowsiness, and taste perversion. It also a has the potential for dependence and addiction. 

The addition of droperidol 2.5 mg to fentanyl 0.4 mg in 40 ml of 0.125% bupivacaine lowered the incidence of postoperative nausea and vomiting compared with a solution without droperidol or with butorphanol added instead in patients undergoing anorectal surgery in a prospective randomized, single-blind study (28). 

As butorphanol is not orally active, reports of its transnasal administration are of interest. The most common adverse effects of transnasal butorphanol were dizziness, nausea and/or vomiting, headache, and drowsiness (SEDA-20, 83). Increased cardiac workload can also occur. 

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]. 

MANAGEMENT OF ADVERSE DRUG REACTIONS Administration of butorphanol, a partial agonist and antagonist of the mu receptor, was able to prevent morphine-induced pruritus without increasing effects of opiate withdrawal including nausea and vomiting [59 ]. 

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