Levorphanol

FDA label

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Titration Allow ~72h after each dose change to reach steady state before further adjustment (long half-life).

Renal Undefined

Hepatic Undefined

Instructions

• Use lowest effective dose for shortest duration.
• Opioid conversion: begin at ~1/15 to 1/12 of prior total daily oral morphine dose (levorphanol is 4–8x morphine potency with longer half-life); underestimate rather than overestimate.
• Reduce initial dose by >=50% in infirm elderly.
• Do not abruptly discontinue in physically dependent patients; taper by <=10–25% of total daily dose every 2–4 weeks.

Contraindications

• Significant respiratory depression
• Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
• Known or suspected GI obstruction, including paralytic ileus

Cautions

• Addiction, abuse, and misuse potential (opioid)
• Life-threatening respiratory depression, esp. at initiation and dose increases
• Serotonin syndrome with concomitant serotonergic drugs
• Adrenal insufficiency and androgen deficiency with prolonged use
• Severe hypotension; profound sedation/respiratory depression with benzodiazepines or CNS depressants
• Opioid-induced hyperalgesia; withdrawal on abrupt discontinuation

Adverse reactions

• Nausea, vomiting
• Constipation, biliary spasm
• Sedation, dizziness, confusion
• Pruritus, sweating, dry mouth
• Respiratory depression
• Hypotension, bradycardia/arrhythmias
• Urinary retention

Pregnancy Insufficient human data; prolonged use can cause neonatal opioid withdrawal syndrome; animal malformations and ~50% embryolethality.

Lactation Undefined