Butorphanol (bue-TOR-fa-nol)

Treats pain that is not relieved by other pain medicines. This medicine is a narcotic pain reliever.

Brand Name(s):

When This Medicine Should Not Be Used:

How to Use This Medicine:

Spray

• Your doctor will tell you how much medicine to use. Do not use more than directed. An overdose can be dangerous. Follow directions carefully so you do not get too much medicine at one time.
• This medicine is for use only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.
• To use:
  • Blow your nose gently to clear the nostrils.
  • Take the cap off of the bottle and remove the clip from the neck of the pump.
  • If you are using the medicine for the first time, you will need to prime the spray pump.
  • To do this, hold the spray bottle with your thumb on the bottom of the bottle and your index and middle fingers on the 2 flaps on the side of the pump.
  • Push down with your index and middle fingers. Keep pumping until you see a fine spray from the bottle.
  • Put the tip of the spray pump into your nostril.
  • Close the other nostril with your finger and lean your head slightly forward.
  • Sniff gently and push down on the 2 flaps to spray the medicine into your nose. Keep your mouth closed as you are breathing in.
  • Take the spray pump out of your nostril and tilt your head back. Sniff a few more times.
• After using the nasal spray, wipe the tip of the bottle with a clean tissue and put the cap back on.
• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Disposal: Ask your pharmacist about the best way to dispose of medicine that you do not use. After you stop using the nasal spray, unscrew the cap, rinse the bottle, and place the parts in a waste container.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how butorphanol works. Tell your doctor if you are using any of the following:
  • Carbamazepine, erythromycin, ketoconazole, mirtazapine, phenytoin, rifampin, ritonavir, theophylline, tramadol, trazodone
  • Medicine to treat anxiety, depression, or other mental health problems (including benzodiazepine medicine, MAO inhibitor, SNRIs, SSRIs, TCAs)
• Do not drink alcohol while you are using this medicine.
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol. Tell your doctor if you are also using buprenorphine, nalbuphine, pentazocine, or a muscle relaxer.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart disease, high blood pressure, lung or breathing problems (including COPD, apnea), adrenal problems, pancreas problems, gallbladder problems, a recent heart attack, or a history of brain tumor, head injury, seizures, alcohol or drug abuse.
• This medicine may cause the following problems:
  • Increased risk of overdose, which can lead to death
  • Respiratory depression (serious breathing problem that can be life-threatening)
  • Serotonin syndrome, when used with certain medicines
• This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.
• This medicine can be habit-forming. Do not use more than your prescribed dose. Call your doctor if you think your medicine is not working.
• Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
• This medicine could cause infertility. Talk with your doctor before using this medicine if you plan to have children.
• This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Keep all medicine out of the reach of children. Never share your medicine with anyone.
• Anxiety, restlessness, fast heartbeat, fever, muscle spasms, twitching, nausea, vomiting, diarrhea, seeing or hearing things that are not there
• Blue lips, fingernails, or skin
• Extreme dizziness or weakness, shallow breathing, slow or uneven heartbeat, sweating, cold or clammy skin, seizures
• Severe confusion, lightheadedness, dizziness, fainting
• Severe constipation, stomach pain
• Trouble breathing or slow breathing

If you notice these less serious side effects, talk with your doctor:

• Mild constipation

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088