Overview
solution for intravenous and intramuscular administration, solution for intramuscular administration
Contraindications
Hypersensitivity to the drug, acute respiratory depression; with epidural and spinal anesthesia - blood clotting disorder (including against the background of anticoagulant therapy), infection (risk of infection in the central nervous system); diarrhea on the background of pseudomembranous colitis caused by cephalosporins, lincosamides, penicillins, toxic dyspepsia (slowing down the elimination of toxins and the associated exacerbation and prolongation of diarrhea).
With caution. Pain in the abdomen of unclear etiology, bronchial asthma, COPD, cardiac arrhythmias, cramps, drug dependence (including history), intracranial hypertension, head injury, respiratory failure, gastrointestinal tract, urinary system, liver and / or renal surgery insufficiency, CHF, acute myocardial infarction, arterial hypertension, hypothyroidism, alcoholism, suicidal tendency, emotional lability, severe inflammatory bowel disease, prostatic hyperplasia, urethral stenosis Nogo channel, seriously ill, weak patients, cachexia, pregnancy, lactation, simultaneous treatment with MAO inhibitors, age 18 years or older than 65 years.
How to use: dosage and course of treatment
With pain - 1 mg of the drug in / in or 2 mg / m every 3-4 hours (or as needed). In elderly patients and in patients with hepatic-renal failure, the dose is reduced by 2 times, and the interval between injections is increased to 6 hours.
For premedication, 2 mg i / m is prescribed for 60-90 minutes before surgery or 2 mg iv immediately before surgery.
When iv Richter administered Butorphanol general anesthesia - 2 mg before administration of sodium thiopental, then anesthesia is supported by repeated iv injections of 0.5-1 mg. The total dose required for anesthesia is 4-12.5 mg.
During childbirth, 1–2 mg i / m or iv is administered to women in labor with a gestational age of at least 37 weeks (in the absence of signs of intrauterine pathology in the fetus) and not more than once every 4 hours, the last injection should be made no later than 4 hours before the estimated delivery time.
Doses of the drug for children under 18 Butorphanol of age not established.
pharmachologic effect
An opioid analgesic for parenteral administration from the group of mixed agonists-antagonists of opioid receptors (stimulates kappa and sigma receptors, blocks mu receptors). The severity of the analgesic effect is similar to morphine. After iv administration, the effect occurs immediately, the maximum effect - after a few minutes; after i / m administration, the effect occurs in 10-15 minutes, maximum activity - in 30-60 minutes, duration of action - 3-4 hours. To a lesser extent than morphine, it depresses breathing, has a lower narcogenic potential, less often than others Opioids cause constipation. It has an antitussive and sedative effect, stimulates the vomiting center, causes pupil constriction, increases systemic blood pressure, pulmonary artery pressure, LV BW and OPSS.
The onset of effect after intramuscular administration is 10-30 minutes, intravenous administration is 2-3 minutes, the time to achieve maximum effect after intramuscular administration is 30-60 minutes, intravenous administration is 30 minutes, duration of effect in the absence of tolerance with a / m introduction - 3-4 hours, a / in the introduction Richter 2-4 prescription
Side effects
From the side of the central nervous system and sensory organs: more often - drowsiness (40%); less often - dizziness, fatigue, general weakness, headache (3%), Richter rarely (less than 1%) - anxiety, nightmares, unusual dreams, restless sleep, euphoria, central nervous system depression, confusion (hallucinations, depersonalization), tinnitus, blurred visual perception, diplopia, in children - paradoxical agitation, anxiety; frequency unknown - cramps, muscle stiffness (especially respiratory), tremors, involuntary muscle twitches, paresthesias.
From the CCC: less often - lowering blood pressure, tachycradia; rarely (less than 1%) - arrhythmia, increased blood pressure.
From the digestive system: less often - anorexia, nausea and / or vomiting (6%); rarely (less than 1%) - constipation, dry mouth, gastrointestinal irritation, with inflammatory bowel disease - paralytic intestinal obstruction and toxic megacolon (constipation, flatulence, nausea, stomach cramps, gastralgia, vomiting); frequency unknown - hepatotoxicity (dark urine, pale stools, icteric sclera and Butorphanol integument).
From the urinary system: less often - decreased urine output, spasm of the ureters (difficulty and pain during urination, frequent urination).
Allergic reactions: rarely (less than 1%) - skin rash (including on the face), Butorphanol, facial flushing, bronchospasm, skin itching.
Local reactions: hyperemia, edema, burning at the injection site.
Other: less often - sweating.
Overdose. Symptoms of acute and chronic overdose: cold, sticky sweat, confusion, dizziness, drowsiness, decreased blood pressure, nervousness, fatigue, bradycardia, severe weakness, slow labored breathing, hypothermia, anxiety, miosis, cramps, hypoventilation, cardiovascular failure, in severe cases - loss of consciousness, respiratory Richter, coma.
Treatment: maintaining adequate pulmonary ventilation, systemic hemodynamics, normal body temperature. Patients should be under continuous monitoring; if necessary - carrying out mechanical ventilation; the use of a specific opioid antagonist - naloxone.
special instructions
In patients with drug addiction, prior to treatment, measures should be taken to completely eliminate the drug from the body.
In experimental studies, there was no teratogenic effect of the drug, but the risk of fetal death in rats and rabbits increased.
In the period of preparation for childbirth, it is prescribed subject to careful medical supervision.
