butorphanol (Rx)

Brand and Other Names:Stadol
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution: Schedule IV

  • 1mg/mL
  • 2mg/mL

nasal spray: Schedule IV

  • 10 mg/mL (1mg/spray)

Pain

Indicated for pain when use of opioid analgesic is appropriate

IV: 1 mg IV q3-4hr PRN; dosage range 0.5-2 mg q3-4hr

IM: 2 mg IM q3-4 hr; dosage range 1-4 mg q3-4hr

Intranasal

  • Initial: 1 mg (1 spray in 1 nostril); may repeat once after 60-90 min if inadequate pain relief
  • Depending on pain severity, by give initial dose of 2 mg (1 spray in each nostril); patient must remain recumbant; do not repeat this dose
  • Maintenance: 1 mg (1 spray in 1 nostril) q3-4hr prn

Balanced Anesthesia

2 mg IV before induction and/or 0.5-1 mg increments during anesthesia (higher dose may be required, up to 0.06 mg/kg, or 4 mg/70 kg)

Total cumulative dose varies; typically ranges between 4-12.5 mg (0.06-0.18 mg/kg)

Labor Pain

Indicated for labor pain in full-term (37 weeks gestation or more) women without fetal distress in early labor

1-2 mg/dose IV/IM; may repeat PRN q4hr

Decrease dose if concomitantly used with other analgesics or CNS depressants

Do not administer within 4 hr of anticipated delivery

Preoperative & Preanesthesia

2 mg IM 60-90 minutes preop

This dose is approximately equipotent to morphine 10 mg or meperidine 80 mg

Renal & Hepatic Impairment

Decrease initial dose by 50% (0.5 mg IV and 1 mg IM)

Increase dose interval from q4hr to q6hr

Intranasal

  • 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control
  • Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn

<18 years old: Not recommended

Pain

Decrease initial dose by 50% (0.5 mg IV and 1 mg IM)

Increase dose interval from q4hr to q6hr

Intranasal

  • 1 mg (1 spray in 1 nostril) initially, may repeat once after 90-120 minutes if inadequate pain control
  • Maintenance: 1 mg (1 spray in 1 nostril) q4-6hr prn
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Interactions

Interaction Checker

and butorphanol

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        Significant - Monitor Closely

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            Contraindicated (1)

            • alvimopan

              alvimopan, butorphanol. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

            Serious - Use Alternative (50)

            • alfentanil

              butorphanol, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • belladonna and opium

              butorphanol, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              butorphanol decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients.

            • buprenorphine

              buprenorphine, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • buprenorphine buccal

              buprenorphine buccal, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • calcium/magnesium/potassium/sodium oxybates

              butorphanol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • cimetidine

              cimetidine increases effects of butorphanol by decreasing metabolism. Avoid or Use Alternate Drug.

            • clonidine

              clonidine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

            • codeine

              butorphanol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • dextromoramide

              butorphanol, dextromoramide. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • diamorphine

              butorphanol, diamorphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • diazepam intranasal

              diazepam intranasal, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • difenoxin hcl

              butorphanol, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • diphenoxylate hcl

              butorphanol, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • dipipanone

              butorphanol, dipipanone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • eluxadoline

              butorphanol, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

            • fentanyl

              fentanyl, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              butorphanol decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • fentanyl intranasal

              fentanyl intranasal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              butorphanol decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • fentanyl transdermal

              fentanyl transdermal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              butorphanol decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • fentanyl transmucosal

              fentanyl transmucosal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              butorphanol decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

            • hydrocodone

              butorphanol decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.

              hydrocodone, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • hydromorphone

              butorphanol, hydromorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • isocarboxazid

              isocarboxazid increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • levorphanol

              butorphanol, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • linezolid

              linezolid increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • meperidine

              butorphanol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • methadone

              butorphanol, methadone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • methylene blue

              methylene blue and butorphanol both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

            • metoclopramide intranasal

              butorphanol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • morphine

              butorphanol, morphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • nalbuphine

              butorphanol, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oliceridine

              butorphanol, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.

            • opium tincture

              butorphanol, opium tincture. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oxycodone

              butorphanol, oxycodone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • oxymorphone

              butorphanol, oxymorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • ozanimod

              ozanimod and butorphanol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • papaveretum

              butorphanol, papaveretum. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • pentazocine

              butorphanol, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • phenelzine

              phenelzine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • procarbazine

              procarbazine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of additive CNS, respiratory and hypotensive effects. .

            • rasagiline

              rasagiline increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. May cause additive CNS depression, drowsiness, dizziness or hypotension, so use with MAOIs should be cautious; lower initial dosages of the analgesic are recommended followed by careful titration. Avoid combination within 14 days of MAOI use.

            • selegiline transdermal

              selegiline transdermal increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

            • selinexor

              selinexor, butorphanol. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sodium oxybate

              butorphanol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sufentanil

              butorphanol, sufentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • sufentanil SL

              butorphanol decreases effects of sufentanil SL by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of opioid mixed agonist/antagonist or partial agonist may reduce sufentail SL analgesic effect and/or precipitate withdrawal symptoms.

              sufentanil SL, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tapentadol

              butorphanol, tapentadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • tramadol

              tramadol, butorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

              butorphanol, tramadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

            • tranylcypromine

              tranylcypromine increases toxicity of butorphanol by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

            • valerian

              valerian and butorphanol both increase sedation. Avoid or Use Alternate Drug.

            Monitor Closely (187)

            • albuterol

              butorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil and butorphanol both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and butorphanol both increase sedation. Use Caution/Monitor.

            • amitriptyline

              butorphanol and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and butorphanol both increase sedation. Use Caution/Monitor.

            • amoxapine

              butorphanol and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              butorphanol and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              butorphanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              butorphanol and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              butorphanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azelastine

              azelastine and butorphanol both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and butorphanol both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              butorphanol and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              butorphanol and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              butorphanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, butorphanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and butorphanol both increase sedation. Use Caution/Monitor.

            • buprenorphine

              buprenorphine and butorphanol both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and butorphanol both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              butorphanol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • butabarbital

              butabarbital and butorphanol both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and butorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              butorphanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and butorphanol both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and butorphanol both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and butorphanol both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and butorphanol both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              butorphanol and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chlorzoxazone and butorphanol both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and butorphanol both increase sedation. Use Caution/Monitor.

            • clemastine

              clemastine and butorphanol both increase sedation. Use Caution/Monitor.

            • clobazam

              butorphanol, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              butorphanol and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and butorphanol both increase sedation. Use Caution/Monitor.

            • clozapine

              butorphanol and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              butorphanol and codeine both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and butorphanol both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and butorphanol both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and butorphanol both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and butorphanol both increase sedation. Use Caution/Monitor.

            • desflurane

              desflurane and butorphanol both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

            • desipramine

              butorphanol and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              butorphanol and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and butorphanol both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              butorphanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and butorphanol both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              butorphanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              butorphanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              butorphanol and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              butorphanol and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • diethylpropion

              butorphanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              butorphanol and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and butorphanol both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and butorphanol both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              butorphanol and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              butorphanol and dipipanone both increase sedation. Use Caution/Monitor.

            • dobutamine

              butorphanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              butorphanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              butorphanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              butorphanol and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              butorphanol and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and butorphanol both increase sedation. Use Caution/Monitor.

            • droperidol

              butorphanol and droperidol both increase sedation. Use Caution/Monitor.

            • ephedrine

              butorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              butorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              butorphanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, butorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and butorphanol both increase sedation. Use Caution/Monitor.

            • ethanol

              butorphanol and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and butorphanol both increase sedation. Use Caution/Monitor.

            • fenfluramine

              butorphanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flibanserin

              butorphanol and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluphenazine

              butorphanol and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • formoterol

              butorphanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gabapentin

              gabapentin, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • haloperidol

              butorphanol and haloperidol both increase sedation. Use Caution/Monitor.

            • hydromorphone

              butorphanol and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and butorphanol both increase sedation. Use Caution/Monitor.

            • iloperidone

              butorphanol and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              butorphanol and imipramine both increase sedation. Use Caution/Monitor.

            • isoproterenol

              butorphanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketamine

              ketamine and butorphanol both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              butorphanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, butorphanol. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levalbuterol

              butorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              butorphanol and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              butorphanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              butorphanol and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              butorphanol and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              loprazolam and butorphanol both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • loxapine

              butorphanol and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              butorphanol and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, butorphanol. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              butorphanol and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              butorphanol and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              butorphanol and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              butorphanol and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              butorphanol and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              butorphanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and butorphanol both increase sedation. Use Caution/Monitor.

            • methadone

              butorphanol and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              butorphanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and butorphanol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              butorphanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and butorphanol both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with opioids increases risk of respiratory depression. Use only when alternative treatment options are inadequate. Use minimum required dosing.

            • midodrine

              butorphanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              butorphanol and mirtazapine both increase sedation. Use Caution/Monitor.

            • modafinil

              butorphanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              butorphanol and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              butorphanol and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              butorphanol and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              butorphanol and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              butorphanol and nalbuphine both increase sedation. Use Caution/Monitor.

            • norepinephrine

              butorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              butorphanol and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              butorphanol and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              oliceridine, butorphanol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • opium tincture

              butorphanol and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              orphenadrine and butorphanol both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • oxycodone

              butorphanol and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              butorphanol and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              butorphanol and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              butorphanol and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              butorphanol and papaverine both increase sedation. Use Caution/Monitor.

            • pegvisomant

              butorphanol decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

            • pentazocine

              butorphanol and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and butorphanol both increase sedation. Use Caution/Monitor.

            • perampanel

              perampanel and butorphanol both increase sedation. Use Caution/Monitor.

            • perphenazine

              butorphanol and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              butorphanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and butorphanol both increase sedation. Use Caution/Monitor.

            • phentermine

              butorphanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              butorphanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              butorphanol increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              butorphanol and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              butorphanol and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              butorphanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pregabalin

              pregabalin, butorphanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone and butorphanol both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              butorphanol and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and butorphanol both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and butorphanol both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              butorphanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              butorphanol and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • quetiapine

              butorphanol and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              butorphanol and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, butorphanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              butorphanol and risperidone both increase sedation. Use Caution/Monitor.

            • salmeterol

              butorphanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              butorphanol and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and butorphanol both increase sedation. Use Caution/Monitor.

            • selegiline

              selegiline increases toxicity of butorphanol by unknown mechanism. Use Caution/Monitor. Concomitant use of butorphanol with other CNS depressants can potentiate the effects of butorphanol on respiratory depression, CNS depression and sedation.hyperpyrexia, somnolence, or death.

            • sevoflurane

              sevoflurane and butorphanol both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              butorphanol and shepherd's purse both increase sedation. Use Caution/Monitor.

            • stiripentol

              stiripentol, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concurrent use of medications with CNS depressant effects together with thalidomide should be avoided due to the risk for additive sedative effects.

            • sufentanil

              butorphanol and sufentanil both increase sedation. Use Caution/Monitor.

            • suvorexant

              suvorexant and butorphanol both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tapentadol

              butorphanol and tapentadol both increase sedation. Use Caution/Monitor.

            • temazepam

              temazepam and butorphanol both increase sedation. Use Caution/Monitor.

            • terbutaline

              butorphanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              butorphanol and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              butorphanol and thiothixene both increase sedation. Use Caution/Monitor.

            • topiramate

              butorphanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              butorphanol and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              butorphanol and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and butorphanol both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and butorphanol both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              butorphanol and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              butorphanol and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and butorphanol both increase sedation. Use Caution/Monitor.

            • xylometazoline

              butorphanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              butorphanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              butorphanol and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              butorphanol and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              butorphanol and zotepine both increase sedation. Use Caution/Monitor.

            Minor (6)

            • brimonidine

              brimonidine increases effects of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dextroamphetamine

              dextroamphetamine increases effects of butorphanol by unspecified interaction mechanism. Minor/Significance Unknown.

            • eucalyptus

              butorphanol and eucalyptus both increase sedation. Minor/Significance Unknown.

            • lidocaine

              lidocaine increases toxicity of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

            • sage

              butorphanol and sage both increase sedation. Minor/Significance Unknown.

            • ziconotide

              ziconotide, butorphanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

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            Adverse Effects

            >10%

            Sedation (43%)

            Dizziness (19%)

            Nasal congestion (13%)

            Nausea and/or vomiting (13%)

            Insomnia (11%)

            1-10%

            Anorexia

            Anxiety

            Blurred vision

            Bronchitis

            Confusion

            Constipation

            Cough

            Dizziness

            Dry mouth

            Dyspnea

            Ear pain

            Epistaxis

            Euphoria

            Floating feeling

            Headache

            Lethargy

            Nasal irritation

            Nervousness

            Paresthesia

            Palpitations

            Pharyngitis

            Pruritis

            Rhinitis

            Sensation of heat

            Sinus congestion

            Sinusitis

            Stomach pain

            Sweating/clammy

            Taste abnormalities

            Tinnitus

            Tremor

            URI

            Vasodilation

            <1%

            Apnea

            Increased/decreased BP

            Bradycardia

            Chest pain

            Respiratory depression

            Tachycardia

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            Warnings

            Contraindications

            Absolute: opioid dependence, respiratory depression, respiratory failure

            Relative: cardiac arrhythmias, cardiovascular disease, coronary insufficiency, myocardial infarction, toxin-mediated diarrhea

            Cautions

            Drug abuse, emotional lability, head injury, hepatic/renal impairment, incr ICP, GI/urinary obstruction, BPH, hypothyroidism

            Less risk of respiratory sedation than with pure opioid agonist

            May produce withdrawal in opioid dependent pts

            Avoid alcohol

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            Pregnancy & Lactation

            Pregnancy Category: C; D if used for prolonged periods or near term

            Lactation: excreted in breast milk, but infant likely exposed to insignificant amounts (AAP Committee states compatible w/ nursing)

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Narcotic agonist-analgesic of kappa opiate receptors and partial agonist of mu opiate receptors; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation

            Pharmacokinetics

            Half-life: 4.6 hr

            Onset: <10 min (IV); 5-10 min (IM); within 15 min (nasal)

            Duration: 3-4 hr (IV/IM); 4-5hr (nasal);

            Peak effect: 0.5-1hr (IM); 4-5min (IV)

            Bioavailability: 60-70% (nasal)

            Protein Bound: 80%

            Vd: 487 L (range: 305-901 L)

            Metabolites: hydroxybutorphanol; N-dealkylation & conjugation of butorphanol & its metabolites)

            Metabolism: Liver (hydroxylation)

            Excretion: Urine (primarily)

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            Administration

            IV Compatibilities

            Syringe: (partial list) atropine, diphenhydramine, fentanyl, hydroxyzine, meperidine, metoclopramide, midazolam, prochlorperazine, promethazine

            Y-site: (partial list) allopurinol, bivalirudin, labetalol, linezolid, propofol

            IV Incompatibilities

            Syringe: dimenhydrinate, pentobarbital

            Y-site: amphotericin B cholesteryl SO4, midazolam

            IV Administration

            pH: 3.0-5.5

            IM/IV injection

            Storage

            Store at room temp

            Protect from freezing

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            butorphanol injection
            -
            2 mg/mL vial
            butorphanol injection
            -
            2 mg/mL vial
            butorphanol injection
            -
            1 mg/mL vial
            butorphanol injection
            -
            1 mg/mL vial
            butorphanol injection
            -
            2 mg/mL vial
            butorphanol injection
            -
            2 mg/mL vial
            butorphanol nasal
            -
            10 mg/mL aerosol
            butorphanol nasal
            -
            10 mg/mL aerosol
            butorphanol nasal
            -
            10 mg/mL aerosol

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            butorphanol injection

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.