Butorphanol (Nasal)

Butorphanol is a fast acting opioid (narcotic) analgesic; it works on the central nervous system, changing how the body senses pain.


Butorphanol belongs to a group of pain medicines called narcotic analgesics, treating mild to severe pain. It works by changing how the pain centers in the central nervous system decipher pain. This medicine modifies the level of pain or completely blocks it.

When it's used for pain management over a long time, it can be habit forming causing mental and physical addictions. Stopping treatment abruptly can cause severe withdrawal symptoms. If you are nearing completion of therapy, your doctor will reduce the dose over time to prevent withdrawal effects before stopping treatment.

Narcotics, alcohol and other medications can be deadly when mixed with other drugs. Certain medications interact with butorphanol nasal spray, increasing the risks of serious side effects. Drinking alcohol or eating foods containing alcohol before treatment can trigger life-threatening events.

This medicine is a Schedule IV Narcotic controlled substance in the United States and listed under the Single Convention on Narcotic Drugs of 1961 prohibiting the production or supply of specific drugs and drugs with similar effects except under license for specific purposes, in this case, medical treatment and research.

Warnings exist due to the risk of abuse, addiction, and misuse. It is illegal to share this prescription.

Condition(s) Treated

Type of Medicine

  • Narcotic pain reliever

Side Effects

Medicines influence some much-needed results, they again cause some unwanted consequences. As individuals, we are unique and how we respond to some medications varies from person to person. Not all these side effects occur in some situations, additional dynamics from lifestyle, genetics, and unknown factors contribute to certain side effects.

Before you start any treatment, talk to your doctor. Share as much information about your medical history, current health ailments and daily routines. Each one of these behaviors has valuable information to help your doctor decide what works best for your condition.

Clinical trials report the most adverse experiences with butorphanol nasal spray are common effects. Pick a comfortable place to lie down before spraying since pain relief comes quickly, you may also feel drowsiness or dizziness sooner.

Here's a list of common, least common and rare side effects. If you experience any of these, or ones not listed tell your doctor or attending nurse. They can't help if they don't know.


  • Anxiety
  • Blurred vision
  • Confusion
  • Constipation
  • Dizziness
  • Dry mouth
  • Euphoria
  • Flu-like symptoms
  • Headache
  • Heart palpitations
  • Insomnia
  • Lethargy
  • Nausea
  • Nervousness
  • Respiratory problems
  • Sleepiness or unusual drowsiness
  • Stomach pain
  • Tremors
  • Vomiting

Least common

  • Bloody nose
  • Body aches or pain
  • Burning
  • Change in taste
  • Clammy skin
  • Congestion
  • Cough
  • Floating feeling
  • Flushing or redness of skin on face and neck
  • Hearing loss
  • Hoarseness
  • Loss of appetite
  • Nasal irritation
  • Pins and needles or tingling
  • Ringing in ears
  • Skin itching
  • Sneezing
  • Trouble swallowing


  • Lack of strength
  • Problems in speaking
  • Sensation of spinning
  • Sweating

Some side effects occur and fade away as your body adjusts to the medication it's a good idea to keep your doctor updated on how you are feeling. DO NOT self-diagnose allow your doctor to do what they do best take care of you. Tell your doctor about the severity of the side effects. If they persist, there are solutions to help prevent or ease the effect.

Sometimes the side effects of butorphanol nasal spray are harmful to your health and fatal. If you experience any of these effects, contact an emergency center and your doctor - ask for help.

  • Change in consciousness
  • Fainting
  • Hallucinations
  • Headache
  • Irregular heartbeats
  • Rash
  • Shallow or slow breathing
  • Swelling in hands and feet


For people who experience more severe pain, the doctor may prescribe an initial dose of one spray in each nostril. Dosage is individualized. The severity of the condition and the patient's circumstances determines the prescription dose.

  • Age
  • One's health status
  • Pathological conditions
  • Use of other medications
  • Weight


These are average doses your doctor may change the dose or its frequency depending on your current health and experiences. This medicine is for use in the nostrils only. Be careful not to get the solution in your eyes or on your skin. If it happens rinse it off immediately with tap water.

If this is your first time using the nasal sprayer you need to make sure the sprayer is working and dispensing the medicine properly. Follow the instructions on the product package for priming the sprayer. If you haven't used the sprayer for more than 48 hours  you need to go through this routine again. Shake the medicine well before each use.

  • Gently blow your nose to clear the nostrils before spraying the medicine.
  • After each use, wipe the tip of the bottle with a clean tissue and put the child-resistant cap back on to prevent leakage.

Your doctor may prescribe butorphanol on a regular schedule for round-the-clock relief of pain. If the pain persists, your need to tell your doctor this could be a sign of an increased tolerance to opioids.

Doses vary - here's an example so you understand how many doses are available in a spray prescription. After priming, a 2.5 milliliter (mL) bottle contains 10 mg of butorphanol nasal spray, you can expect at least 10 to 12 doses, depending on how much priming is needed.

It takes about 15 minutes for butorphanol to calm the pain. The peak activity occurs within one to two hours. The time spans vary from person to person. The effect may last as long as four to five hours.

This is a recommended dose for an initial dose.

  • Adult - 1 milligram (mg): one spray in one nostril
    Repeat the same dosage every three to four hours
    Children - Dose is decided by your doctor.

DO NOT spray more than once during each application dosage control helps to manage and reduce an incident of drowsiness and dizziness causing disorientation and potentially falling, inducing an injury. By controlling the dose, it may also ease the level of severity for side effects. You should not operate a vehicle or machinery after administering a dose of this nasal spray. If the pain persists talk with your doctor.

  • Adult - Your doctor may prescribe another 1 mg spray in 60 to 90 minutes from the initial spray if the pain persists.
    Repeat the sequences as instructed.
    Children - Dose is decided by your doctor.

Depending on the level of pain your doctor may change the initial dose and increase the incremental dosage for long-term treatments.

  • Adult - 2 mg one spray in each nostril
    Repeat the same dosage every three to four hours
    Maximum dose should not exceed over 16 mg daily.
    Children - Dose is decided by your doctor.

If you are instructed by your doctor to administer the 2 mg dose be sure you are laying down the drowsiness or dizziness may match the volume of the medicine taken. Your doctor will continue to monitor your body's response and the effectiveness of butorphanol to decide if this is working for you.

Missed Dose

If you miss a dose, take it as soon as possible with one exception. If you are close to the next scheduled dose, skip the missed dose and continue your regular dosing.

  • DO NOT double doses in an attempt to catch up - you may trigger overdose effects. Keep your doctor updated when you miss a dose.


Serious precautions are needed when choosing to use this medicine. Accidental overdoses or intentional misuse of butorphanol has critical consequences based on the volume dispensed and the individual's response.

The possibility of unknown drugs in your system, foods containing alcohol, health supplements or over-the-counter medications being taken and failure to tell your doctor - can cause an overdose reaction.

It helps to educate your family and friends on how to recognize the symptoms of an overdose. In the event of an overdose call for help immediately and contact your doctor. Your doctor and the emergency crew are prepared to help with an overdose.

Other Medicines or Health Procedures

If you are taking any of these medicines for other health ailments tell your doctor. Some of these may be prescriptions and others may be over-the-counter medicines. In some instances, these medicines may be used for preoperative procedures be sure to tell the doctor about your surgery schedules.

The important issue here - these medicines may contain an active ingredient that will alter your response to the butrophanel nasal spray. They could also trigger a harmful reaction.

  • Antihistamines for allergies, coughs or a cold
  • General anesthetics like halothane, isoflurane, methoxyflurane or propofol
  • Local anesthetics like lidocaine, pramoxine, or tetracaine
  • Medicines for anxiety or sleep
  • Medicines for depression - amitriptyline, fluoxetine, sertraline
  • Medicines for seizures - phenobarbital, primidone
  • Medicines that relax muscles for surgery
  • Narcotic medicines for pain or coughs
  • Nasal decongestants - oxymetazoline
  • Phenothiazines - chlorpromazine, mesoridazine, prochlorperazine or thioridazine
  • Sumatriptan nasal spray


In some situations, two different medicines are used to treat an illness and replace a natural deficiency found in the body. Certain medicines should not be used together because they work against each other causing secondary effects. When there's an unexpected result using butorphanol, your doctor may change the dose of one or both of the medicines.

You need to be honest about your lifestyle routines alcohol consumption and tobacco, drug addictions, health supplements, over-the-counter medicines and herbal remedies may cause severe life-threatening interactions with this drug.

To help avoid these interactions, here's a list of medicines known to interact with butorphanol. There may be other medicines not listed you need to share information on all the medications you are taking now and any sensitivities or allergies you have to medicines with your doctor.

  • Acepromazine
  • Alfentanil
  • Alphaprodine
  • Alprazolam
  • Amisulpride
  • Amobarbital
  • Anileridine
  • Aripiprazole
  • Asenapine
  • Baclofen
  • Benperidol
  • Bromazepam
  • Bromopride
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Carbinoxamine
  • Cariprazine
  • Carisoprodol
  • Carphenazine
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Codeine
  • Cyclobenzaprine
  • Dantrolene
  • Dexmedetomidine
  • Diacetylmorphine
  • Diazepam
  • Dichloralphenazone
  • Difenoxin
  • Dihydrocodeine
  • Diphenhydramine
  • Diphenoxylate
  • Donepezil
  • Doxylamine
  • Droperidol
  • Enflurane
  • Estazolam
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Fentanyl
  • Flibanserin
  • Flunitrazepam
  • Fluphenazine
  • Flurazepam
  • Fluspirilene
  • Fospropofol
  • Halazepam
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxyzine
  • Iloperidone
  • Isoflurane
  • Ketamine
  • Ketazolam
  • Ketobemidone
  • Levorphanol
  • Lorazepam
  • Lormetazepam
  • Lurasidone
  • Meclizine
  • Medazepam
  • Melperone
  • Meperidine
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methotrimeprazine
  • Methylene Blue
  • Midazolam
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Nicomorphine
  • Nitrazepam
  • Nitrous Oxide
  • Olanzapine
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Papaveretum
  • Paregoric
  • Pentazocine
  • Pentobarbital
  • Perampanel
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenobarbital
  • Pimavanserin
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piritramide
  • Prazepam
  • Primidone
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Propoxyphene
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Remifentanil
  • Remoxipride
  • Risperidone
  • Secobarbital
  • Sertindole
  • Sodium Oxybate
  • Sufentanil
  • Sulpiride
  • Suvorexant
  • Tapentadol
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Thiothixene
  • Tilidine
  • Tizanidine
  • Tolonium Chloride
  • Topiramate
  • Tramadol
  • Triazolam
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Zaleplon
  • Ziprasidone
  • Zolpidem
  • Zopiclone
  • Zotepine

Drug Interactions

Doctors are alert to the possibilities of drug interactions for this reason, initial doses are small and long-term treatments are monitored. There are approaches to reduce the risks without eliminating one of your other drugs used to treat an existing disorder. On the other hand drugs like barbiturates, tranquilizers, and antihistamines are dangerous when combined with this drug they can increase the central nervous system depressant effects.

Your doctor's concerns about interactions include the risks of taking you off a current medication or changing the dose either approach could worsen the interaction.

Existing Health Disorders

Before starting any treatment or therapy using this drug, your doctor will conduct a health evaluation and review lab test data to make sure this drug is safe to use. If you have been treated for any of these health illnesses tell your doctor. Some medications linger in the body, causing unwanted effects with butorphanol.

  • Alcohol abuse
  • Breathing problems
  • Drug dependence
  • Brain tumor
  • Head injuries
  • Increased pressure in the head
  • Heart attack
  • Heart or blood vessel problems
  • Hypertension (high blood pressure)
  • Kidney disease
  • Liver disease


This drug is harmful when used incorrectly. Using butorphanol nasal spray exposes patients to the risks of opioid addiction or abuse. Your doctor will watch your response and behavior to prevent misuse, causing unsafe or toxic effects during and after treatment.

The U.S. Food and Drug Administration (FDA) regularly post notices on drugs like butorphanol. Because this medication can be habit forming, this organization recommends avoiding certain patients and conditions that may trigger dependence to this drug or other opioids.

  • Take this medication only as prescribed.
  • DO NOT share this medicine with anyone else.
  • This medication is not recommended for patients dependent on narcotics.
  • Follow the doctor's dose schedule - DO NOT take multiple doses.
  • Follow your doctor's instruction when you're told to stop.


When prescribing this medicine to patients with a history of drug abuse - serious precautions are necessary. New patients diagnosed with long-term pain management can form a physical dependence.

  • Frequent monitoring is important to prevent the risk of abuse or addiction.

Age Groups


Information on the using this medicine for this age group is insufficient. Studies do not report reasonable or expected effects when using this medicine. Talk to the doctor before starting treatment the solution may include lower controlled doses or alternative medicines better suited for your child.

  • Safety and efficacy for the pediatric population has not been established.
  • Accidental exposure to children can result in a fatal incident.
  • This medicine is not recommended for children under the age of 18 years.


The current studies on the effect of this medicine and the geriatric population has shown an effectiveness when using butorphanol to treat the condition. Although, there are precautions with this elderly group, due to age, exiting health condition and the other medications being taken may cause a higher level of sensitively to this medicine.

  • Age plays a critical role requiring a dose adjustment and extensive monitoring when using this nasal spray.


If you are pregnant and use this medicine, it can cause neonatal opioid withdrawal syndrome. This condition occurs in a newborn, exposed by an addiction use or prescription drug while in the mother's womb. If you go into labor while using this medicine your doctor may discontinue use. This spray can prolong labor and temporarily reduce the duration and frequency of uterine contractions.

  • Use birth contraceptives while using this nasal spray.

Nursing Mothers

Butorphanol has been found in breast milk after mothers use the nasal spray. Some reports confirm no adverse reactions to breast milk; other reports cite infants ingesting butorphanol breast milk may experience an increase in sleepiness, breathing difficulties and other side effects.

  • If you notice, unusual symptoms contact your doctor.


Chronic use of opioids is known to reduce fertility in both females and males. It is not known, if the effects are reversible.


Take extra precautions when storing and handling butorphanol nasal spray. Keep this medicine and wrappings from the package out of reach of children and pets. Store it at room temperature, avoid direct light and DO NOT freeze it.

  • DO NOT share or dispense this medicine with anyone else the results could be fatal.
  • Avoid skin and eye contact if needed, rinse the area several times with cool water.
  • Contact your health care facility, doctor, or pharmacist for disposal of unused butorphanol.
  • DO NOT flush it or dispose of it in the household trash containers.


Butorphanol nasal spray is a noninvasive choice of medication for pain management when an opioid analgesic is applicable. The efficiency of opioid analgesics like butorphanol varies in different pain disorders. This is a controlled substance with risks associated to your well-being take the time to discuss these risks with your doctor and fully understand the consequences, before starting therapy.