Butorphanol nasal spray may be habit forming. Use butorphanol nasal spray exactly as directed. Do not use more or less of it, use it more often, stop using it suddenly, or use it in a different way than directed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or has had an overdose, or if you have or have ever had depression or another mental illness.
Butorphanol nasal spray may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.
Butorphanol nasal spray may harm or cause death to other people who use your medication, especially children. Keep butorphanol nasal spray in a safe place so that no one else can take it accidentally or on purpose.
Taking certain other medications, drinking alcohol, or using street drugs with butorphanol nasal spray may increase the risk of serious or life-threatening breathing problems. Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Your doctor may need to change the doses of your medication and will monitor you carefully.
Tell your doctor if you are pregnant or plan to become pregnant. If you use butorphanol nasal spray regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth.
Your doctor or pharmacist will give you the Medication Guide. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm to obtain the Medication Guide.Talk to your doctor about the risks of using butorphanol nasal spray for your condition.
Why is this medicine prescribed?
Butorphanol nasal spray is used to relieve severe pain. Butorphanol is in a class of medications called opioid agonist-antagonists. It works by changing the way the body senses pain.
Are there other uses for this medicine?
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
How should this medicine be used?
Butorphanol nasal spray comes as a solution (liquid) to spray in the nose. Use it as needed for pain every 3 to 4 hours.
Butorphanol nasal spray should relieve your pain soon after you use it. Your doctor may tell you to use a second dose if you still have pain 60 to 90 minutes after your first dose. Do not use this second dose unless your doctor tells you that you may do so. Tell your doctor if you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain during your treatment with butorphanol nasal spray. Do not use more of it or use it more often than prescribed by your doctor. You may receive a dangerous overdose if you use more medication or use your medication more often than prescribed by your doctor.
Talk to your doctor or pharmacist about access to rescue medicines, naloxone or nalmefene, while using butorphanol. Rescue medications can reverse the life-threatening effects of an opioid overdose and are available over the counter or with a prescription. Make sure that you and your family members and people usually around you know how to recognize an overdose, how to use naloxone or nalmefene, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and others how to use it. If symptoms of an overdose occur, they should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. If your symptoms return, the person should give you another dose of the rescue medication. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.
Do not stop using butorphanol nasal spray without talking to your doctor. If you suddenly stop using butorphanol nasal spray, you may experience withdrawal symptoms such as nervousness, agitation, shakiness, diarrhea, chills, sweats, difficulty falling asleep or staying asleep, loss of coordination, confusion, or hallucinations (seeing things or hearing voices that do not exist). Your doctor will probably decrease your dose gradually.
Before you use butorphanol nasal spray for the first time, read the written directions provided by the manufacturer. Ask your doctor or pharmacist if you have any questions about how to use butorphanol nasal spray.
To use butorphanol nasal spray, follow these directions:
- Gently blow your nose.
- Remove the clear cover and protective clip from the bottle.
- If you are using a new pump or a pump that has not been used in 48 hours or longer, you must prime the pump before use. Hold the bottle so that the nozzle is between your first and second fingers and your thumb is on the bottom. Be sure that the bottle is aimed away from you, other people, and animals. Pump the bottle firmly and quickly (up to 8 strokes) until a fine spray appears.
- Insert the tip of the sprayer approximately 1/2 inch (1 cm) into one nostril, pointing the tip toward the back of your nose.
- Close your other nostril with your finger and tilt your head slightly forward.
- Pump the spray firmly and quickly one time and sniff gently with your mouth closed.
- Remove the sprayer from your nose. Tilt your head backward and sniff gently for a few seconds.
- Replace the protective clip and cover on the spray bottle. Put the bottle back in the child-resistant storage container.
What special precautions should I follow?
Before using butorphanol nasal spray,
- tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
- some medications should not be taken with butorphanol nasal spray. Make sure you have discussed any medications you are currently taking or plan to take before starting butorphanol nasal spray with your doctor and pharmacist. Before starting, stopping, or changing any medications while using butorphanol nasal spray, please get the advice of your doctor or pharmacist.
- tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, or tranylcypromine.
- the following nonprescription or herbal products may interact with butorphanol nasal spray: St. John's wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using butorphanol nasal spray. Do not start these medications while using butorphanol nasal spray without discussing it with your healthcare provider.
- tell your doctor if you have or have ever had slowed breathing, asthma, chronic pulmonary disease (COPD), or other lung problems or have or ever had a blockage or narrowing of your stomach or intestine, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to use butorphanol nasal spray.
- tell your doctor if you have or have ever had a brain tumor, or any condition that increases the amount of pressure in your brain; seizures; or pancreas, gallbladder, thyroid, heart, kidney, or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking butorphanol nasal spray, call your doctor.
- you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using butorphanol nasal spray.
- you should know that butorphanol nasal spray may make you drowsy or dizzy. Do not drive a car or operate machinery for at least 1 hour after using butorphanol nasal spray. After 1 hour has passed, do not drive until you are sure that you are not dizzy, drowsy, or less alert than usual.
- you should know that butorphanol nasal spray may cause drowsiness, dizziness, or fainting, especially during the first hour after you use the medication. Be sure that you have a comfortable place available in case you need to lie down after you use the medication.
- you should know that butorphanol nasal spray may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are using butorphanol nasal spray.
- you should know to not drink alcoholic beverages while you are taking butorphanol nasal spray. Alcohol can make the side effects from butorphanol worse.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget to take a dose?
Butorphanol nasal spray is usually used as needed. If your doctor has told you to use butorphanol nasal spray regularly, use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
What should I do in case of overdose?
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
Symptoms of overdose may include the following:
- slow or shallow breathing, difficulty breathing
- excessive sleepiness, unable to respond or wake up
- narrowing or widening of the pupils (dark circle in the eye)
- cold, clammy skin
- slowed heartbeat
What side effects can this medicine cause?
Butorphanol nasal spray may cause side effects. Tell your doctor if any of these symptoms or those in the SPECIAL PRECAUTIONS section are severe or do not go away:
- nausea, vomiting
- decreased sexual desire, inability to get or keep an erection
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- seizures
- slowed or irregular breathing
- agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
- extreme drowsiness
- nausea, vomiting, loss of appetite, weakness, or dizziness
- chest pain, irregular or pounding heartbeat
- rash; hives; hoarseness; difficulty breathing or swallowing; or swelling of the face, mouth, tongue or throat
- new pain or pain from touch or doing ordinary tasks such as combing your hair
- difficulty swallowing, regurgitation (bringing up swallowed food into throat and mouth), pain in the chest area
- unusual snoring or long pauses during breaths during sleep
Butorphanol nasal spray may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( https://www.fda.gov/Safety/MedWatch ) or by phone ( 1-800-332-1088).What should I know about storage and disposal of this medication?
Store butorphanol nasal spray in its child-resistant container, tightly closed and out of reach of children, and in a location that is not easily accessible by others, including visitors to the home. Store it at room temperature and away from excess heat and moisture (not in the bathroom). You must immediately dispose of butorphanol nasal spray as soon as it becomes outdated or is no longer needed through a medicine take-back program.
Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.What other information should I know?
Keep all appointments with your doctor.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are using butorphanol.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.