Dosing and uses of Levo Dromoran (levorphanol)
Adult dosage forms and strengths
tablet: Schedule II
- 2mg
Pain
Opiate-naive
- 2 mg PO q6-8hr PRN
- 1 mg IM/SC q6-8hr PRN
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24 hr PRN
Prior opiate exposure
- 2-4 mg PO q6-8hr PRN
- 1-2 mg IV/SC q6-8hr PRN
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24hr PRN
Premedication
1-2 mg/dose IM/SC 60-90 min prior to surgery
Renal Impairment
Use caution; reduce initial dose in severe renal impairment
Hepatic Impairment
Use caution; reduce initial dose in severe hepatic impairment
Other Indications & Uses
General anesthesia, local anesthesia
Pediatric dosage forms and strengths
<18 yo: not recommended
Geriatric dosage forms and strengths
Pain
Opiate-naive
- 2 mg PO q6-8hr PRn
- 1 mg IM/SC q6-8hr PRn
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24 hr PRn
Prior opiate exposure
- 2-4 mg PO q6-8hr PRn
- 1-2 mg IV/SC q6-8hr PRn
- 1 mg slow IV q3-6hr; not to exceed 4-8 mg/24hr PRn
Premedication
1-2 mg/dose IM/SC 60-90 min prior to surgery
Levo Dromoran (levorphanol) adverse (side) effects
>10%
Dizziness
Hypoventilation
Nausea
Pruritus
1-10%
Hypotension
Constipation
Vomiting
Disturbance of consciousness
Disturbance in mood
<1%
Bradyarrhythmia
Cardiac arrest
Cardiac dysrhythmia
Palpitations
Tachyarrhythmia
Apnea
Warnings
Contraindications
Absolute: acute abdominal condition, pseudomembranous colitis, respiratory depression
Relative: asthma (acute), inflammatory bowel disease, respiratory impairment
Cautions
Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased intracranial pressure, prostatic hypertrophy, renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgery, toxin-mediated diarrhea
Pregnancy and lactation
Pregnancy category: B; D if used for prolonged periods or near term
Lactation: not known if excreted in breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Levo Dromoran (levorphanol)
Mechanism of action
Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation
Pharmacokinetics
Half-Life: 12-16 hr
Onset of action: 10-60 min (PO)
Duration: 4-8 hr
Peak Plasma Time: 20 min (IV); 60-90 min (SC)
Metabolism: Liver (conjugation with glucuronic acid)
Excretion: Urine (primarily)
Administration
IV Incompatibilities
Additive: aminophylline, ammonium chloride, amobarbital, chlorothiazide, heparin, pentobarbital, phenobarbital, phenytoin, sodium bicarbonate, thiopentaL
IV Administration
IV: inject 3 mg over 4-5 min
Storage
Store at room temp
Protect from freezing
