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Get free insider access to aspect about your body that you would like to change. Thanks for your question. I'm sorry to hear that Steve is having these problems. Is it Tramadol or Torbutrol that Steve is on? From what you are describing, it sounds like the Torbutrol is what is working for Steve which is surprising because it usually doesn't work too well for pain in dogs. Regarding Tramadol, we get ours in our clinic compounded at a compounding pharmacy.

The one we use is called Summit Pharmacy. Emergence from anesthesia was comparable with both agents. In a total of patients Butorphanol 1 mg and 2 mg was as effective as 40 mg and 80 mg of meperidine patients in the relief of pain in labor with no effect on the duration or progress of labor.

Both drugs readily crossed the placenta and entered fetal circulation. The condition of the infants in these studies, determined by Apgar scores at 1 and 5 minutes 8 or above and time to sustained respiration, showed that Butorphanol had the same effects on the infants as meperidine. In these studies neurobehavioral testing in infants exposed to Butorphanol injection at a mean of For pain relief the recommended initial dosage regimen of Butorphanol tartrate injection is 1 mg IV or 2 mg IM with repeated doses every three to four hours as necessary.

This dosage regimen is likely to be effective for the majority of patients. Dosage adjustments of Butorphanol injection should be based on observations of its beneficial and adverse effects. The initial dose in the elderly and in patients with renal or hepatic impairment should generally be half the recommended adult dose 0.

The usual preoperative dose is 2 mg IM given 60 to 90 minutes before surgery or 2 mg IV shortly before induction. This is approximately equivalent in sedative effect to 10 mg morphine or 80 mg of meperidine.

This single preoperative dose should be individualized based on age, body weight, physical status, underlying pathological condition, use of other drugs, type of anesthesia to be used and the surgical procedure involved. During maintenance in balanced anesthesia the usual incremental dose of Butorphanol tartrate is 0.

The incremental dose may be higher, up to 0. The total dose of Butorphanol injection will vary; however, patients seldom require less than 4 mg or more than As with other opioids of this class, Butorphanol injection may not provide adequate intraoperative analgesia in every patient or under all conditions. A failure to achieve successful analgesia during balanced anesthesia is commonly reflected by increases in general sympathetic tone.

Consequently, if blood pressure or heart rate continue to rise, consideration should be given to adding a potent volatile liquid inhalation anesthetic or another intravenous medication.

In labor, the recommended initial dose of Butorphanol tartrate is 1 or 2 mg IM or IV in mothers with fetuses of 37 weeks gestation or beyond and without signs of fetal distress. Dosage adjustments of Butorphanol in labor should be based on initial response with consideration given to concomitant analgesic or sedative drugs and the expected time of delivery.

Indications and Usage for Butorphanol Butorphanol Tartrate Injection is indicated - as a preoperative or pre-anesthetic medication - as a supplement to balanced anesthesia - for the relief of pain during labor, and - for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Limitations of Use Because of the risks of addiction, abuse, and misuse, with opioids, even at recommended doses [see WARNINGS ], reserve Butorphanol tartrate for use in patients for whom alternative treatment options [e. Although the risk of addiction in any individual is unknown, it can occur in patients appropriately prescribed Butorphanol tartrate. Addiction can occur at recommended dosages and if the drug is misused or abused.

Assess each patient's risk for opioid addiction, abuse, or misuse prior to prescribing Butorphanol tartrate injection, and monitor all patients receiving Butorphanol tartrate for the development of these behaviors or conditions. Risks are increased in patients with a personal or family history of substance abuse including drug or alcohol abuse or addiction or mental illness e.

The potential for these risks should not, however, prevent the proper management of pain in any given patient. Patients at increased risk may be prescribed opioids such as Butorphanol tartrate, but use in such patients necessitates intensive counseling about the risks and proper use of Butorphanol tartrate along with intensive monitoring for signs of addiction, abuse, and misuse. Opioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion. Consider these risks when prescribing or dispensing Butorphanol tartrate.

Strategies to reduce these risks include prescribing the drug in the smallest appropriate quantity. Contact local state professional licensing board or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product. Life-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended.

Respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death. Carbon dioxide CO2 retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids. While serious, life-threatening, or fatal respiratory depression can occur at any time during the use of Butorphanol tartrate, the risk is greatest during the initiation of therapy or following a dosage increase. Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy with and following dosage increases of Butorphanol tartrate.

Overestimating the Butorphanol tartrate dosage when converting patients from another opioid product can result in a fatal overdose with the first dose. Neonatal Opioid Withdrawal Syndrome Prolonged use of Butorphanol tartrate during pregnancy can result in withdrawal in the neonate. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts.

Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Profound sedation, respiratory depression, coma, and death may result from the concomitant use of Butorphanol tartrate with benzodiazepines or other CNS depressants e. Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioid analgesics alone.

If the decision is made to prescribe a benzodiazepine or other CNS depressant concomitantly with an opioid analgesic, prescribe the lowest effective dosages and minimum durations of concomitant use. In patients already receiving an opioid analgesic, prescribe a lower initial dose of the benzodiazepine or other CNS depressant than indicated in the absence of an opioid, and titrate based on clinical response.

If an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response. Follow patients closely for signs and symptoms of respiratory depression and sedation. Advise both patients and caregivers about the risks of respiratory depression and sedation when Butorphanol tartrate is used with benzodiazepines or other CNS depressants including alcohol and illicit drugs.

Advise patients not to drive or operate heavy machinery until the effects of concomitant use of the benzodiazepine or other CNS depressant have been determined. Life-Threatening Respiratory Depression in Patients with Chronic Pulmonary Disease or in Elderly, Cachectic, or Debilitated Patients The use of Butorphanol tartrate in patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment is contraindicated.

Patients with Chronic Pulmonary Disease Butorphanol tartrate-treated patients with significant chronic obstructive pulmonary disease or cor pulmonale, and those with a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression are at increased risk of decreased respiratory drive including apnea, even at recommended dosages of Butorphanol tartrate [see WARNINGS ].

Elderly, Cachectic, or Debilitated Patients Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see WARNINGS ].

Monitor such patients closely, particularly when initiating and titrating Butorphanol tartrate and when Butorphanol tartrate is given concomitantly with other drugs that depress respiration [see WARNINGS ]. Alternatively, consider the use of non-opioid analgesics in these patients.

Adrenal Insufficiency Cases of adrenal insufficiency have been reported with opioid use, more often following greater than 1 month of use. Serving Patients We negotiate with the pharmacy industry on behalf of all Americans.

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