When used frequently, butorphanol nasal spray has the potential to become a habit. Apply butorphan nasal spray precisely as instructed. Use it only as prescribed by your doctor, and don’t take more of it, use it more frequently, or use it in a different way. Discuss your pain management options, treatment duration, and pain treatment goals with your doctor while using butorphanol nasal spray. Inform your doctor if you or any members of your family regularly use excessive amounts of alcohol, use illicit drugs, abuse prescription drugs, or have ever experienced depression or another mental disease. If you currently have or have ever had any of these conditions, there is a higher chance that you may overuse butorphanol. If you suspect that you may have an opioid addiction, speak with your doctor right away and ask for advice, or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Breathing issues from butorphanol nasal spray can be severe or even fatal, especially in the first 24 to 72 hours of treatment and whenever the dose is raised. Throughout your therapy, your doctor will keep a close eye on you. If you have asthma or slow breathing, let your doctor know. Most likely, your doctor will advise against using butorphanol nasal spray. Additionally, let your doctor know whether you currently have or have ever had a lung condition like COPD. A set of conditions that affect the lungs and airways), a brain tumour, a head injury, or any condition that raises the pressure inside of your skull. The likelihood that you will experience breathing issues may be increased if you are an older adult, weak, or undernourished as a result of a sickness. Get emergency medical care if you encounter any of the following symptoms, or call your doctor right away: sluggish breathing, protracted breath gaps, or shortness of breath.

The risk of serious or life-threatening respiratory issues may rise while using other drugs along with butorphanol nasal spray. If you already take or intend to take any of the following medications, inform your doctor and pharmacist right away: a few antifungal drugs, such as carbamazepine (Carbatrol, Epitol, Tegretol, Teril), itraconazole (Onmel, Sporanox), ketoconazole, and voriconazole (Vfend);  drugs for anxiety, mental illness, or nausea, including benzodiazepines such flurazepam, estazolam, and chlordiazepoxide (Librium), as well as clonazepam, valium, and diazepam, clarithromycin (Biaxin, in PrevPac) muscle relaxants; lorazepam (Ativan), oxazepam, temazepam (Restoril), and triazolam (Halcion); erythromycin (Erytab, Erythrocin); in addition to various narcotic painkillers, phenytoin (Dilantin, Phenytek), rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate), sedatives, sleeping pills, or tranquillizers, several HIV drugs, such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir. Your prescription doses may need to be adjusted, and your doctor will closely monitor you.

While receiving therapy with butorphanol nasal spray, using illicit substances, drinking alcohol, or taking prescription or over-the-counter medications that include alcohol increases your risk of developing these severe, perhaps fatal adverse effects. Don’t consume alcohol or use illicit substances while receiving treatment.

If you are pregnant or want to become pregnant, let your doctor know. Regular usage of butorphanol nasal spray during pregnancy may put your unborn child in danger of experiencing life-threatening withdrawal symptoms. If your infant exhibits any of the following symptoms, contact your doctor straight away: irritability, hyperactivity, disturbed sleep, high-pitched crying, excessive shaking of a body part, vomiting, diarrhoea, or failure to gain weight.

The manufacturer’s patient information sheet (Medication Guide) will be sent to you by your doctor or pharmacist when you start using butorphanol nasal spray and each time you fill a prescription for it. If you have any questions, carefully read the material and contact your doctor or pharmacist. The Medication Guide is also available on the manufacturer’s website or the Food and Drug Administration (FDA) website.

A nasal spray containing butorphanol is used to treat moderate to severe pain. Butorphanol belongs to a group of drugs known as opioid agonist-antagonists. It functions by altering how the body perceives pain.

The butorphanol nasal spray is a liquid solution that is sprayed into the nose. It is typically used for pain as needed, but not more than once every three to four hours. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following.

The butorphanol nasal spray ought to make your pain disappear shortly after using it. Your doctor may advise you to use a second dose of butorphanol nasal spray if you are using a modest initial dose if you are still experiencing pain 60 to 90 minutes after your first dose. Use this second dose only if your doctor instructs you to. If discomfort persists after taking the butorphanol nasal spray as directed, consult your doctor. If you have been using butorphanol nasal spray for a while and notice that it is no longer as effective as it was when you first started your therapy, you should also call your doctor.

Avoid stopping butorphanol nasal spray usage without first consulting your doctor. You could have withdrawal symptoms like anxiety, agitation, trembling, shakes, diarrhoea, chills, sweats, trouble falling asleep or staying asleep, lack of coordination, confusion, or hallucinations if you suddenly stop using butorphanol nasal spray (seeing things or hearing voices that do not exist). Your dose will likely be gradually reduced by your doctor.

Read the manufacturer’s written instructions before using butorphanol nasal spray for the first time. If you have any concerns regarding how to use butorphanol nasal spray, see your physician or pharmacist.

The steps below should be followed to utilise a butorphanol nasal spray:

1. sanitise your hands.
2. Blow your nose gently.
3. Take off the bottle’s protective clasp and clear cover.
4. You must prime the pump before usage if it is a new pump or one that hasn’t been used in at least 48 hours. Hold the bottle with your thumb on the bottom and the nozzle situated between your first and second fingers. Aim the bottle away from you, other people, and any nearby animals. Until a fine spray appears, forcefully and swiftly pump the bottle (up to 8 strokes).
5. Pointing the sprayer’s tip toward the back of your nose, insert it into one nostril about 1/4 inch (0.6 cm) deep.
6. Tilt your head slightly forward and cover the other nostril with your finger.
7. Squeeze the spray vigorously and fast once, then gently inhale while keeping your mouth shut.
8. Your nose should be free of the sprayer. Lean your head back and take a few slow, deep breaths.
9. Replace the spray bottle’s cover and protecting clasp. Place the bottle back into the storage container with child safety locks.

The manufacturer’s patient information sheet (Medication Guide) will be sent to you by your doctor or pharmacist when you start using butorphanol nasal spray and each time you get a prescription refill. If you have any questions, carefully read the material and contact your doctor or pharmacist. The Medication Guide is also available on the Food and Drug Administration (FDA) website.

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

Before using butorphanol nasal spray,

• If you have an allergy to butorphanol, any other drugs, or benzethonium chloride, tell your doctor and pharmacist (a preservative found in some medications and personal care products). For a list of the ingredients, consult the Medication Guide or speak with your pharmacist.
• Inform your doctor and pharmacist about any vitamins, nutritional supplements, herbal items, and prescription and over-the-counter medicines you are now taking or intend to take. Any of the following should be mentioned: antidepressants, antihistamines, barbiturates such butabarbital (Butisol), pentobarbital (Nembutal), phenobarbital, or secobarbital (Seconal), cyclobenzaprine (Amrix), dextromethorphan (a cough suppressant included in Nuedexta), lithium (Lithobid); such as sumatriptan (Alsuma, Imitrex, in Treximet), almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig); mirtazapine (Remeron); alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi) are 5HT3 serotonin blockers. Nasal sprays such as oxymetazoline (Afrin, Dristan, and other brands) are another option. Serotonin and norepinephrine reuptake inhibitors like duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pristiq), milnacipran (Savella), and venlafaxine (Effexor); Selective Serotonin-Reuptake Inhibitors like citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), theophylline (Theochron, Uniphyl, and other brands); trazodone (Oleptro); and tricyclic antidepressants (often known as “mood elevators”) such amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protript (Surmontil). Additionally, let your doctor or pharmacist know if you’re receiving any of the following monoamine oxidase (MAO) inhibitors or if you’ve recently stopped taking them: methylene blue, isocarboxazid (Marplan), linezolid (Zyvox), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Tell your doctor about all of the medications you are taking, even any not on this list, as many other drugs may interact with butorphanol. Your physician might need to adjust the dosage of your drugs or keep a close eye on you for side effects.
• Please let your doctor know if you are taking any herbal supplements, especially St. John’s wort and tryptophan.
• If you have or have ever had any of the disorders listed in the IMPORTANT WARNING section, as well as a blockage in your stomach or intestine like a paralytic ileus, let your doctor know (condition in which digested food does not move through the intestines). You could be advised by your doctor not to use butorphanol nasal spray.
• Inform your doctor if you experience or have ever experienced urinary incontinence, heart attacks, seizures, high blood pressure, or conditions affecting your thyroid, pancreas, gallbladder, heart, kidneys, or liver.
• Inform your doctor if you are nursing a child.
• You should be aware that this medicine may lower both male and female fertility. The dangers of using butorphanol should be discussed with your doctor.
• Inform your doctor or dentist that you use butorphanol nasal spray if you are having surgery, including dental surgery.
• It’s important to be aware that butorphanol nasal spray can make you feel sleepy, lightheaded, or faint, especially in the first hour after using it. In case you need to lie down after taking the prescription, make sure you have a cosy space available. After using butorphanol nasal spray, wait at least one hour before operating machinery or a vehicle. After one hour, refrain from driving until you are certain that you are not feeling lightheaded, sleepy, or less alert than normal.
• It’s important to be aware that butorphanol nasal spray can result in constipation. While using butorphanol nasal spray, discuss with your doctor whether you should alter your diet or take other drugs to prevent or cure constipation.

Keep eating normally unless your doctor instructs you otherwise.

When necessary, butorphanol nasal spray is often applied. Use the missed dose as soon as you remember it if your doctor has instructed you to use butorphanol nasal spray on a regular basis. If the next dose is soon due, skip the missed one and carry on with your regular dosing plan. To make up for a missing dose, do not take a second one.

Side effects from butorphanol nasal spray are possible. If any of these symptoms are severe or do not go away, let your doctor know right once:

• Drowsiness
• Extreme fatigue
• Having trouble falling or staying asleep
• Strange dreams
• Constipation
• Abdominal pain
• Sensing heat
• Flushing
• Hands or foot pain, burning, numbness, or tingling
• Body part shaking that is uncontrollable
• Nervousness
• Hostility
• Intensely happy
• Floating sensation
• Depressing, unpleasant, or uncomfortable emotion
• Fuzzy vision
• Hearing ringing
• Ears hurt
• Unfavourable flavour
• Mouth ache
• Having trouble urinating
• Nosebleed
• Inflamed or congested nose
• Unwell throat

Some adverse effects can be very harmful. Call your doctor right away if you have any of the following symptoms:

• Decreased breathing
• Agitation, hallucinations (hearing voices or seeing things that are not there), disorientation, fever, sweating, shivering, extremely stiff or twitching muscles, loss of coordination, nausea, vomiting, or diarrhoea
• Nausea, vomiting, weight loss, anorexia, or lightheadedness
• Failure to achieve or maintain erection
• Irregular periods of time
• Less sexual arousal
• Having trouble breathing
• Fainting
• Erratic or rapid heartbeat
• Headache
• Lightheadedness
• Rash
• Hives

Other adverse effects of butorphanol nasal spray are possible. If you experience any strange issues while taking this medicine, contact your doctor right away.

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme online or by phone if you have a serious side event (1-800-332-1088).

Keep the child-resistant bottle of butorphanol nasal spray tightly closed and out of children’s reach. Store it away from excessive heat and moisture at room temperature (not in the bathroom). Butorphanol nasal spray should be disposed of by unscrewing the top, washing the bottle, and putting the pieces in the trash as soon as it expires or is no longer required.

As many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Additionally, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

If you use butorphanol nasal spray, you should speak to your doctor about keeping naloxone, a life-saving drug, close at hand (e.g., home, office). Naloxone is used to undo an overdose’s potentially fatal consequences. To treat harmful symptoms brought on by excessive levels of opiates in the blood, it functions by inhibiting the effects of opiates. If you live with young children or someone who has abused prescription or illicit drugs, your doctor could also advise you to get naloxone. Make sure you, your family, your caretakers, and anyone else who spends time with you are aware of the signs of an overdose, how to administer naloxone, and what to do until emergency assistance arrives. You and your family members will be shown how to use the medication by your doctor or pharmacist. For the directions, speak to your pharmacist or go to the manufacturer’s website. If you start to experience overdose symptoms, a friend or family member should administer the first dose of naloxone, contact 911 right away, and stay by your side while keeping a careful eye on you until emergency medical assistance comes. After receiving naloxone, your symptoms can come back a short while later. The person should administer you another dose of naloxone if your symptoms come back. If symptoms reappear before receiving medical attention, more doses may be given every 2 to 3 minutes.

Overdose signs could include the following:

Keep all of your appointments with your physician and the lab. To monitor your body’s reaction to butorphanol, your doctor will request specific lab tests.

Inform your doctor and the lab staff that you are using butorphanol prior to any laboratory test (particularly those involving methylene blue).

Do not share your medication with anybody else. Any queries you may have regarding medication refills should be directed to your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.