Description and Brand Names

Drug information provided by: Micromedex

US Brand Name

  1. Levo-Dromoran

Descriptions


Levorphanol is used to relieve moderate to severe pain. It belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

When levorphanol is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

  • Tablet

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of levorphanol in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of levorphanol in the elderly. However, elderly patients are more likely to have age-related kidney or liver problems, which may require caution and an adjustment in the dose for patients receiving levorphanol.

Pregnancy

Information about this levorphanol-oral-route
Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Naltrexone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Adinazolam
  • Alfentanil
  • Alprazolam
  • Anileridine
  • Bromazepam
  • Brotizolam
  • Buprenorphine
  • Butalbital
  • Butorphanol
  • Carbinoxamine
  • Carisoprodol
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Chlorzoxazone
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Codeine
  • Dantrolene
  • Dezocine
  • Diazepam
  • Estazolam
  • Ethchlorvynol
  • Fentanyl
  • Flunitrazepam
  • Fluphenazine
  • Flurazepam
  • Fospropofol
  • Halazepam
  • Hydrocodone
  • Hydromorphone
  • Ketazolam
  • Levorphanol
  • Lorazepam
  • Lormetazepam
  • Meclizine
  • Medazepam
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Metaxalone
  • Methocarbamol
  • Methohexital
  • Midazolam
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Nitrazepam
  • Nordazepam
  • Opium
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Pentazocine
  • Perphenazine
  • Prazepam
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propoxyphene
  • Quazepam
  • Remifentanil
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thioridazine
  • Triazolam
  • Trifluoperazine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Perampanel
  • Risperidone

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Addison's disease (adrenal gland problem) or
  • Alcohol abuse, history of or
  • Breathing or lung problems (e.g., chronic obstructive pulmonary disease [COPD], hypoxia) or
  • Drug dependence, especially narcotic abuse or dependence, or history of or
  • Enlarged prostate (BPH, prostatic hypertrophy) or
  • Hypothyroidism (an underactive thyroid) or
  • Infection, severe or
  • Mental illness, history of or
  • Problems with passing urine—Use with caution. May increase risk for more serious side effects.
  • Brain tumor or
  • Head injuries or
  • Increased pressure in your head—Some of the side effects of levorphanol can cause serious problems in people who have these medical problems.
  • Breathing problems (e.g., asthma), severe or
  • Gallbladder surgery—Should not be used in patients with these conditions.
  • Heart disease or
  • Hypotension (low blood pressure) or
  • Myocardial infarction (heart attack) or
  • Respiratory depression (hypoventilation or slow breathing)—Use with caution. May make these conditions worse.
  • Kidney disease or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
  • Stomach or digestion problems—This medicine may mask the diagnosis of these conditions.

Proper Use

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who may be more sensitive to the effects of pain medicines. If too much of this medicine is taken for a long time, it may become habit-forming (causing mental or physical dependence).

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For moderate to severe pain:
      • Adults—At first, 2 milligrams (mg) every 6 to 8 hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 6 to 12 mg per day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is very important that your doctor check your progress while you are using this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the other medicines listed above while you are using this medicine.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve dizziness or lightheadedness.

This medicine may make you dizzy, drowsy, or lightheaded. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Do not change your dose or suddenly stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn babies. Tell your doctor right away if your child has the following symptoms: abnormal sleep pattern, diarrhea, high-pitched cry, irritability, shakiness or tremor, weight loss, vomiting, or failure to gain weight.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

  1. Agitation
  2. attempts at killing oneself
  3. bluish lips or skin
  4. blurred vision
  5. change in consciousness
  6. cold, clammy skin
  7. confusion
  8. decrease in the frequency of urination
  9. decrease in urine volume
  10. decreased urine output
  11. depression
  12. difficulty in passing urine (dribbling)
  13. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  14. extra heartbeats
  15. extremely shallow or slow breathing
  16. fast, slow, irregular, pounding, or racing heartbeat or pulse
  17. fast, weak pulse
  18. hostility
  19. lethargy
  20. lightheadedness
  21. loss of consciousness
  22. muscle twitching
  23. no blood pressure or pulse
  24. not breathing
  25. painful urination
  26. rapid weight gain
  27. seizures
  28. stopping of the heart
  29. stupor
  30. sweating
  31. swelling of the face, ankles, or hands
  32. unconsciousness
  33. unusual tiredness or weakness
  34. wheezing

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

  1. Chest pain or discomfort
  2. constricted, pinpoint, or small pupils (black part of the eye)
  3. decreased awareness or responsiveness
  4. difficult or troubled breathing
  5. difficulty with sleeping
  6. dilated neck veins
  7. disorientation
  8. drowsiness to profound coma
  9. extreme fatigue
  10. hallucination
  11. headache
  12. irregular, fast or slow, or shallow breathing
  13. no muscle tone or movement
  14. not breathing
  15. pale or blue lips, fingernails, or skin
  16. shortness of breath
  17. sleepiness or unusual drowsiness
  18. swelling of the face, fingers, feet, or lower legs
  19. weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

  1. Abnormal dreams
  2. absence of or decrease in body movement
  3. acid or sour stomach
  4. belching
  5. change in personality
  6. changes in vision
  7. delusions
  8. dementia
  9. discouragement
  10. double vision
  11. dry mouth
  12. feeling sad or empty
  13. heartburn
  14. hives or welts
  15. increase in body movements
  16. indigestion
  17. irritability
  18. itching
  19. lack of appetite
  20. loss of interest or pleasure
  21. loss of memory
  22. nausea
  23. nervousness
  24. problems with memory
  25. redness of the skin
  26. seeing double
  27. skin rash
  28. stomach discomfort, upset, or pain
  29. sweating
  30. tiredness
  31. trouble concentrating
  32. trouble sleeping
  33. twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
  34. upper abdominal or stomach pain
  35. vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.