Butorphanol nasal spray

What is this medicine?

BUTORPHANOL (byoo TOR fa nole) is a pain reliever. It is used to treat moderate to severe pain.

How should I use this medicine?

The medicine is only for use in the nose. Follow the directions on the prescription label. Make sure that you are using your inhaler correctly. Ask you doctor or health care provider if you have any questions.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Patients over 65 years old may have a stronger reaction and need a smaller dose.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

• breathing problems

• confusion

• signs and symptoms of low blood pressure like dizziness; feeling fait or lightheaded, falls; unusually weak or tired

• trouble passing urine or change in the amount of urine

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• bleeding, congested, or runny nose

• constipation

• dry mouth

• nausea, vomiting

• tiredness

What may interact with this medicine?

• alcohol

• antihistamines for allergy, cough and cold

• certain medicines for anxiety or sleep

• certain medicines for depression like amitriptyline, fluoxetine, sertraline

• certain medicines for seizures like phenobarbital, primidone

• general anesthetics like halothane, isoflurane, methoxyflurane, propofol

• local anesthetics like lidocaine, pramoxine, tetracaine

• medicines that relax muscles for surgery

• nasal decongestants like oxymetazoline

• other narcotic medicines for pain or cough

• phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine

• sumatriptan nasal spray

What if I miss a dose?

This does not apply. Use the medicine as needed for pain.

Where should I keep my medicine?

Keep out of the reach of children. This medicine can be abused. Keep your medicine in a safe place to protect them from theft. Do not share this medicine with anyone. Selling or giving away this medicine is dangerous and is against the law.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light.

Discard unused medicine and used packaging carefully. Pets and children can be harmed if they find used or lost packages. Do not use the medicine after the expiration date. Follow the directions in the MedGuide.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• brain tumor

• drug abuse or addiction

• head injury

• heart disease

• if you frequently drink alcohol-containing drinks

• kidney disease

• liver disease

• lung or breathing disease, like asthma

• an allergic reaction to butorphanol, opioid analgesics, benzethonium chloride, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

What should I watch for while using this medicine?

Tell your health care provider if your pain does not go away, if it gets worse, or if you have new or a different type of pain. You may develop tolerance to this drug. Tolerance means that you will need a higher dose of the drug for pain relief. Tolerance is normal and is expected if you take this drug for a long time.

Do not suddenly stop taking your drug because you may develop a severe reaction. Your body becomes used to the drug. This does NOT mean you are addicted. Addiction is a behavior related to getting and using a drug for a nonmedical reason. If you have pain, you have a medical reason to take pain drug. Your health care provider will tell you how much drug to take. If your health care provider wants you to stop the drug, the dose will be slowly lowered over time to avoid any side effects.

If you take other drugs that also cause drowsiness like other narcotic pain drugs, benzodiazepines, or other drugs for sleep, you may have more side effects. Give your health care provider a list of all drugs you use. He or she will tell you how much drug to take. Do not take more drug than directed. Get emergency help right away if you have trouble breathing or are unusually tired or sleepy.

Talk to your health care provider about naloxone and how to get it. Naloxone is an emergency drug used for an opioid overdose. An overdose can happen if you take too much opioid. It can also happen if an opioid is taken with some other drugs or substances, like alcohol. Know the symptoms of an overdose, like trouble breathing, unusually tired or sleepy, or not being able to respond or wake up. Make sure to tell caregivers and close contacts where it is stored. Make sure they know how to use it. After naloxone is given, you must get emergency help right away. Naloxone is a temporary treatment. Repeat doses may be needed.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand up or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this drug. Avoid alcoholic drinks.

This drug will cause constipation. If you do not have a bowel movement for 3 days, call your health care provider.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy and drinking plenty of water may help. Contact your health care provider if the problem does not go away or is severe.