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Below is a rephrased version of the drug safety information and warnings for butorphanol, ensuring clarity and comprehension while retaining all critical details:

When considering the use of butorphanol, it is vital to be aware of the following safety information and warnings. If you have any questions or concerns, please discuss them with your healthcare provider.

• Potentially Life-Threatening Respiratory Depression: Butorphanol may cause dangerously slowed breathing, which can occur at any time, especially when starting the medication or increasing the dose. Avoid alcohol and other sedatives, such as benzodiazepines and muscle relaxants, as these can exacerbate breathing difficulties. Seek immediate medical attention if you experience difficulty breathing or notice bluish discoloration of lips, fingers, or toes. Consider discussing the availability of naloxone (Narcan) with your provider as a precaution. Individuals at increased risk include those over 65, those with weakened health, pre-existing respiratory conditions, and those using medications or substances that also depress breathing.

• Risk of Addiction and Misuse: Butorphanol carries a risk of addiction even when used as prescribed. Misuse can also lead to overdose. To mitigate this risk, your healthcare provider will prescribe the minimal effective dose for the shortest duration necessary. Individuals with a personal or family history of substance abuse or mental health disorders may be at greater risk.

• Accidental Overdose: An overdose of butorphanol can occur even at prescribed doses, and it is particularly dangerous if ingested by children or others by accident. Your provider may advise carrying naloxone (Narcan, Evzio) to counteract an overdose. Learn the signs, such as slowed breathing, extreme drowsiness, or unresponsiveness, and call 911 immediately if an overdose is suspected. Higher risk groups include those with a history of opioid use disorder, previous overdoses, or those taking other sedative medications.

• Impact on Newborns During Pregnancy: Prolonged use of butorphanol during pregnancy can cause the unborn child to become dependent, leading to neonatal opioid withdrawal syndrome after birth. Symptoms in newborns can include excessive crying, poor feeding, and irritability, which require prompt medical attention. Inform your healthcare provider if you have used butorphanol during pregnancy.

• Dangerous Interactions with Other Substances: Butorphanol can interact with various medications, potentially altering its effectiveness or increasing the risk of severe side effects such as respiratory depression. Avoid alcohol and consult your provider before taking any new medications, including over-the-counter drugs.

• Hormonal Changes: Long-term use of butorphanol may lead to decreased hormone levels, presenting symptoms like nausea, fatigue, and weakness. Notify your healthcare provider if these occur.

• Blood Pressure Fluctuations: Butorphanol may cause sudden changes in blood pressure, leading to dizziness or fainting, especially shortly after taking the medication. Those with heart conditions should be particularly cautious.

• Increased Seizure Risk: Individuals with a history of seizures may experience more frequent episodes while taking butorphanol. Report any increase in seizure activity to your healthcare provider.

• Drowsiness and Impaired Reaction Time: Butorphanol can cause significant drowsiness, affecting your ability to drive or operate machinery safely. Exercise caution until you understand how the medication affects you.

• Physical Dependence and Withdrawal: Prolonged use of butorphanol can result in physical dependence, with withdrawal symptoms occurring if the medication is stopped abruptly. Gradual dose reduction under medical supervision is essential to prevent withdrawal.

Lastly, butorphanol should not be used in individuals with severely slowed breathing, severe asthma, gastrointestinal blockages, or an allergy to benzethonium chloride. Always consult your healthcare provider if any of these conditions apply to you.

Common side effects:

• Drowsiness
• Dizziness
• Nausea or vomiting

Less common but important to monitor:

• Stuffy nose
• Trouble sleeping

Serious side effects:

• Headache
• Weakness
• Constipation
• Dry mouth
• Tremor or shakiness
• Confusion
• Anxiety
• Sweating
• Itching

When taking butorphanol, it's important to be aware of potential interactions with other substances, as these can affect how the medication works and may lead to serious side effects. Here are some key interactions to consider:

Central Nervous System (CNS) Depressants: Combining butorphanol with other CNS depressants—such as benzodiazepines, sedatives, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, or alcohol—can significantly increase the risk of profound sedation, respiratory depression, coma, and even death. If such combinations are deemed necessary, they should be reserved for patients without adequate alternative treatment options, and the lowest effective dosages and shortest durations should be used. Patients and caregivers should be informed about these risks and educated on recognizing signs of respiratory depression and sedation.

Serotonergic Drugs: Using butorphanol alongside medications that affect serotonin levels—like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, certain muscle relaxants (e.g., Cyclobenzaprine, Metaxalone), and monoamine oxidase inhibitors (MAOIs)—can lead to a potentially life-threatening condition called serotonin syndrome. Symptoms may include agitation, hallucinations, rapid heartbeat, high or low blood pressure, fever, nausea, vomiting, diarrhea, muscle rigidity, dizziness, tremor, and seizures. If combined use is necessary, patients should be closely monitored, especially during the start of treatment and when adjusting doses. Butorphanol should be discontinued if serotonin syndrome is suspected.

Monoamine Oxidase Inhibitors (MAOIs): There is limited information on the concurrent use of butorphanol and MAOIs. However, due to the potential for serious interactions, patients are advised to avoid using these drugs together.

Other Opioids: Combining butorphanol with other opioid medications can lead to additive effects, increasing the risk of respiratory depression, sedation, and hypotension. Additionally, butorphanol may reduce the effectiveness of other opioids and could precipitate withdrawal symptoms in individuals dependent on opioids. Therefore, concurrent use should be approached with caution.

Anticholinergic Drugs: Concurrent use of butorphanol with anticholinergic medications may heighten the risk of urinary retention and severe constipation, potentially leading to a condition called paralytic ileus, where the intestines stop moving properly. Patients should be monitored for signs of these conditions when these drugs are used together.

Alcohol: Consuming alcohol while taking butorphanol can amplify CNS depressant effects, resulting in increased drowsiness, dizziness, impaired judgment, and coordination difficulties. In severe cases, this combination can lead to low blood pressure, respiratory distress, fainting, coma, or death. Patients are strongly advised to avoid alcohol during butorphanol treatment.

Always inform your healthcare provider about all medications, supplements, and substances you are currently using to ensure safe and effective use of butorphanol.