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Levorphanol

(leh-vor-fun-ohl)

Trade/other name(s): Levo-Dromoran

Why would this drug be used?

Levorphanol is used to treat moderate to severe pain. It may be used to control surgical pain or cancer pain, and may be used for other purposes.

How does this drug work?

Levorphanol is a man-made (synthetic) opioid pain reliever, similar to morphine. It works by binding to opioid receptors in the brain and nervous system, reducing the perception of pain as well as the emotional response to pain.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), low thyroid function, heart disease, or Addison's disease (low adrenal function). These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have had abdominal pain or any disorder with slowed or blocked intestines, such as paralytic ileus. Levorphanol can worsen this problem.
  • If you have trouble passing urine, narrow urethra, or if you have an enlarged prostate. Levorphanol can make it harder to urinate.
  • If you have ever had a seizure, head injury, or if you have had problems with pressure, infection, or a tumor in your head or brain. Levorphanol can raise your risk of seizures.
  • If you have low blood pressure. Levorphanol can worsen this.
  • If you have asthma, emphysema, chronic bronchitis, sleep apnea, or other breathing problem. Levorphanol can make it worse.
  • If you have gallstones, gallbladder disease, or pancreatitis. Levorphanol can sometimes worsen these problems.
  • If you have taken monoamine oxidase inhibitors within the past 2 weeks (see drug interactions section, below.) Levorphanol can cause coma, slow or shallow breathing, low blood pressure, excitability, seizures, or shock.
  • If you drink alcohol or take any medicine that can affect your brain or nervous system. These may worsen the side effects of levorphanol or cause other problems.
  • If you have trouble with addiction, alcohol, or drug abuse now or have had one in the past. Levorphanol can be habit forming, especially for those who have had problems before.
  • If you have severe mental illness. Levorphanol can worsen psychosis.
  • If any family members have or have had an addiction or drug problem. Levorphanol is sometimes stolen by or for those who have become addicted to it or similar drugs.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy, especially later in pregnancy.
  • If you are breast-feeding. It is unknown whether this drug passed into breast milk. If it does, it may affect the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Buprenorphine (Subutex, Suboxone), butorphanol (Stadol), nalbuphine (Nubain), or pentazocine (Talwin, Talacen) may decrease the effects of levorphanol or stop its action altogether. This can cause withdrawal if you have taken the levorphanol for some time.

Antidepressants of the older MAO inhibitor type such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may cause coma, slow or shallow breathing, low blood pressure, excitability, seizures, or shock if levorphanol is given within 2 weeks of the last MAO inhibitor dose.

Medicines Medicines or substances that slow down the brain or nervous system, such as these, can cause worse side effects if taken with levorphanol:

  • anti-anxiety drugs (tranquilizers or sedatives)
  • sleeping pills
  • muscle relaxers
  • barbiturates
  • anti-seizure medicines
  • other opioid drugs
  • anesthetics
  • antidepressants such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline
  • anti-psychotic drugs
  • certain anti-nausea medicines
  • alcohol

Some of these can cause slowed breathing, low blood pressure, extreme sleepiness, coma, or even death if taken with levorphanol.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Levorphanol can be given as a pill taken by mouth. Levorphanol can also be given by injection.

There are 2 ways levorphanol pills can be prescribed. Most often it is prescribed to be taken when pain is bothering you, on an "as needed" basis. Sometimes it is prescribed on a regular schedule, to be taken whether or not you notice pain. It is usually taken no more often than every 6 to 8 hours. Your doctor may prescribe it to be taken more or less often than this. Take it as directed, with a full glass of water.

The dose depends on how much is needed to control your pain. Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children, pets, and others. Discard unused medicine if you no longer need it by flushing it down the toilet. Do not let others use your medicine.

Precautions

This medicine can cause drowsiness and lightheadedness. Do not drive, operate machinery, or perform other activities that require alertness until you know how you react to this medicine.

Levorphanol can make you feel dizzy or faint, and increase your risk of falling. Be careful getting up, changing position, or walking. Get up slowly and hold onto something or someone to keep you steady. If you feel lightheaded or dizzy, it may help to lie down. It is best to have a responsible adult with you for the first few days after starting the levorphanol and after any increase in dose, until you know how you will respond to it.

Since levorphanol affects the brain and nervous system, do not take other drugs or substances that slow down the brain or nervous system such as alcohol, sedatives, muscle relaxers, and sleeping pills unless your doctor tells you to do so.

Call your doctor right away if you have trouble breathing, get short of breath, dizzy, faint, confused, or very drowsy. These may be signs your dose is too high, or you could have gotten an accidental overdose of the medicine.

Tell your doctor or nurse right away if you have trouble passing your urine, trouble walking, or other problems.

Call your doctor right away if you have trouble breathing, get short of breath, feel very drowsy, or start seeing or hearing things that aren't there. These may be signs your dose is too high, or you could have gotten an accidental overdose of the medicine.

If you are having any kind of surgery or medical procedure, be sure to tell the doctor or dentist in charge that you are using this medicine.

Constipation is a very common side effect of taking opioid pain medicines. While you're taking levorphanol, you should take medicines such as stool softeners, bulk-forming agents, and/or laxatives as needed to have regular (daily) bowel movements. Talk to your nurse or doctor about this when you first start this medicine. Drink plenty of fluids throughout the day, and try to eat foods high in fiber such as whole grains, bran, fruits, and vegetables. Call your doctor or nurse right away if you have not moved your bowels in 2 days.

Most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.

If you have chronic (long term) cancer pain, talk to your doctor about taking your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain comes back between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.

Talk to your doctor or nurse about using the smallest effective dose to reduce side effects and the development of tolerance and physical dependence. Tolerance means that larger doses are needed to get the same pain relief. Physical dependence means that the body goes into withdrawal if drug is suddenly stopped. Both happen normally when strong (opioid) medicines are taken over several weeks to treat chronic pain. But this is different from addiction, which starts when the drug is taken for rather than pain relief. Tell your doctor or nurse if you still have pain even though you are taking the medicine as directed. Do not adjust your dose without talking to your doctor or nurse.

Do not stop taking this medicine without talking to your doctor or nurse. When no longer needed, this medicine should be stopped gradually with the help of your doctor. If it is stopped too quickly or the dose reduced too much, you can have withdrawal symptoms, such as restlessness, irritability, anxiety, runny nose, watering eyes, yawning, sweating, chills, gooseflesh, aches, nausea, vomiting, poor appetite, high blood pressure, fast heartbeat, and fast breathing.

Acetaminophen or aspirin may be taken along with levorphanol to increase the pain relief action. It is important to know if any of your other medicines contain either of these drugs. They are in many remedies and it is easy to accidentally get too much of them. Check with your doctor, nurse, or pharmacist to find out which of these drugs are included in your daily medicines.

This drug is a controlled substance, and may be habit forming. Do not allow others to take your medicine. A person who has taken levorphanol for a long time often needs large doses for pain relief, while the same amount could quickly kill someone else.

If you think you or someone else may have taken an overdose of levorphanol, get emergency help right away. Symptoms of levorphanol overdose may include extreme drowsiness, slow heart beat, slow or irregular breathing, cold clammy skin, or coma. Levorphanol overdose may cause the heart or breathing to stop.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • constipation*
  • drowsiness*
  • sedation*
  • nausea
  • dry mouth

Less common

  • changes in mood
  • euphoria (happiness)
  • depression
  • mental clouding, confusion*
  • slow or shallow breathing*
  • vomiting
  • delayed digestion
  • low blood pressure (can make you dizzy or faint when sitting or standing up)*
  • slow heart rate or irregular heart beat

Rare

  • bowel rupture due to severe constipation*
  • decreased sexual interest
  • impotence
  • trouble urinating
  • facial flushing (redness)
  • itching
  • sweating
  • withdrawal symptoms if drug is stopped or dose reduced too quickly*
  • spasm of bile duct
  • seizures

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984).

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 11/11/2009
Last Revised: 11/11/2009