butorphanol
Brand names: Stadol
Butorphanol nasal spray is a strong pain medicine. It is used when other pain medicines are not strong enough or cannot be tolerated.
Drug Pricing (NADAC)
Generic Price
$12.56/unit
Generic Available
Yes (4 manufacturers)
Pricing data from NADAC (CMS), effective December 18, 2024. Compare all drug costs →
What it does
This medicine treats severe pain that requires an opioid pain reliever.
Common side effects
Sleepiness, Dizziness, Nausea
Key warnings
This medicine has serious warnings.
How It Works
Butorphanol is an opioid agonist-antagonist. It works by changing how your brain and nervous system respond to pain. It attaches to certain receptors in the brain to reduce pain signals.
How to Take It
Only a healthcare provider who knows about opioid medicines should prescribe this nasal spray. Use the lowest dose that works for the shortest time needed. For each spray, prime the pump by pressing firmly and releasing several times. If you don't use it for 48 hours, you will need to prime it again.
Pregnancy & Breastfeeding
If you need to use this medicine for a long time during pregnancy, it can cause withdrawal symptoms in your newborn. Make sure a newborn specialist is available when you deliver your baby.
Missed Dose
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your next dose at the regular time.
Storage
Store at room temperature between 68°F to 77°F and keep it in a safe place.
Side Effects (from patient reports)
Based on 245 FDA adverse event reports.
FDA Adverse Event Report Analysis
Detailed analysis of 318 reports from the FDA Adverse Event Reporting System (FAERS). Reports span 2002–2025.
Total Reports
318
Death-Related Reports
7
Hospitalization Reports
48
Top Indication
Migraine
Gender Distribution
Age Distribution
Most Reported Adverse Reactions (FAERS)
| # | Reaction | Reports |
|---|---|---|
| 1 | DRUG HYPERSENSITIVITY | 48 |
| 2 | DRUG INEFFECTIVE | 45 |
| 3 | PRODUCT DOSE OMISSION ISSUE | 36 |
| 4 | NAUSEA | 25 |
| 5 | HEADACHE | 16 |
| 6 | PAIN | 16 |
| 7 | PRURITUS | 16 |
| 8 | VOMITING | 15 |
| 9 | ANXIETY | 14 |
| 10 | DYSPNOEA | 14 |
| 11 | MIGRAINE | 13 |
| 12 | PRODUCT QUALITY ISSUE | 13 |
| 13 | DIZZINESS | 12 |
| 14 | PRODUCT PACKAGING QUANTITY ISSUE | 11 |
| 15 | DEPRESSION | 10 |
Reactions in Death Reports
Reactions in Hospitalization Reports
Source: FDA FAERS (Adverse Event Reporting System) FDA FAERS (Adverse Event Reporting System) Reports are voluntary and do not establish causation
Serious Warnings
This medicine has serious warnings. It can cause addiction, abuse, and misuse, which can lead to overdose and death. It can also cause life-threatening breathing problems, especially when you first start using it or after a dose increase. Accidental use, even one dose, can cause a fatal overdose, especially in children. Using this medicine with benzodiazepines or other drugs that can make you sleepy, including alcohol, can cause serious problems, including coma and death. If you use this medicine for a long time during pregnancy, it can cause withdrawal symptoms in the newborn that could be life-threatening if not treated.
Known Drug Interactions
Intervention: Avoid concomitant use Examples: Butorphanol, nalbuphine, pentazocine, buprenorphine Muscle Relaxants Clinical Impact: Oxycodone may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.
Mechanism: These drugs both slow down your breathing and can make your muscles very weak when taken together.
What to do: You should avoid using these two medications at the same time.
Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics The concomitant use of opioids with other opioid analgesics, such as butorphanol, nalbuphine, pentazocine, may reduce the analgesic effect of PERCOCET and/or precipitate withdrawal symptoms.
Mechanism: Butorphanol can block the pain-relieving effects of oxycodone and may cause sudden withdrawal symptoms. This happens because the two drugs compete for the same spots in your body's nervous system.
What to do: Avoid using these two types of pain medications together to ensure your pain is managed and to prevent withdrawal.
Examples: butorphanol, nalbuphine, pentazocine Muscle Relaxants Clinical Impact: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.
Mechanism: These medicines can work together to slow your breathing and make your muscles very weak. This increases the risk of serious breathing problems.
What to do: Your doctor should monitor you for slow breathing and may need to adjust your treatment plan.
Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics The concomitant use of opioids with other opioid analgesics, such as butorphanol, nalbuphine, pentazocine, may reduce the analgesic effect of acetaminophen and codeine phosphate tablets and/or precipitate withdrawal symptoms.
Mechanism: Butorphanol can block the pain-relieving effects of codeine and may cause sudden, uncomfortable withdrawal symptoms.
What to do: Avoid using these two medicines at the same time to ensure your pain is managed safely.
Examples: Butorphanol, nalbuphine, pentazocine, buprenorphine.
Mechanism: Butorphanol can block the pain-relieving effects of fentanyl or cause sudden withdrawal symptoms because it works differently on the same brain receptors.
What to do: Avoid using these two medicines together. Your doctor may need to adjust your pain management plan.
Common Questions
Can this medicine cause addiction?
What should I do if I accidentally spray this in my child's face?
Can I drink alcohol while using this medicine?
How many sprays are in one bottle?
What should I do if I have trouble breathing?
Can I drive while taking this medicine?
What is naloxone?
What should I tell my doctor before taking this medicine?
How often can I use this nasal spray?
What if this medicine stops working?
What are the common side effects of butorphanol?
Does butorphanol interact with other medications?
What drug class is butorphanol?
Is butorphanol safe during pregnancy?
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Vicodin, Norco
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What the FDA Data Shows for butorphanol
The FDA label for butorphanol (sold under brand names such as Stadol) classifies it as a prescription-only medication in the Opioid Agonist-Antagonist class. This medicine treats severe pain that requires an opioid pain reliever. Official labeling lists 6 commonly reported side effects, including Sleepiness, Dizziness, Nausea.
Post-market surveillance from the FDA Adverse Event Reporting System (FAERS) captures real-world experience. For this drug, FAERS contains 245 voluntary reports. The database also lists 11 documented drug interactions derived from FDA labeling, with the top-flagged interaction rated moderate severity. NADAC pricing from CMS shows a generic unit cost of $12.56.
Report counts do not establish causation — a FAERS entry documents a temporal association, not proof that the drug produced the outcome. Widely prescribed medications naturally accumulate more reports than niche therapies, so raw totals must be interpreted alongside total exposure. Shortage status, recall history, and patent information further shape supply and switching decisions. This page summarizes public FDA data for educational purposes only and is not a substitute for professional medical advice — always consult a licensed healthcare provider before starting, stopping, or changing any medication.
Data Sources
Drug labeling: FDA Drug Labels (SPL/DailyMed). Adverse events: FDA Adverse Event Reporting System (FAERS). Pricing: CMS National Average Drug Acquisition Cost (NADAC).
FAERS reports are voluntary and do not establish causation. Drug interactions are derived from FDA labeling and clinical references. Always consult a healthcare professional before making medication decisions.
Last updated: April 17, 2024
Read our methodology — how this data is sourced, computed, and verified.
All federal data sources used on this page
- FDA Orange Book — approved drug products with therapeutic equivalence. accessdata.fda.gov/cder/ob
- FDA DailyMed — NIH-hosted drug labeling for FDA-approved meds. dailymed.nlm.nih.gov
- FDA Adverse Event Reporting System (FAERS) — post-marketing safety surveillance. fda.gov/drugs/faers
- NLM RxNorm — standardized clinical drug nomenclature. nlm.nih.gov/research/umls/rxnorm
- CMS Medicare Part B Drug Average Sales Price Files — federal drug pricing data. cms.gov/medicare/part-b-drugs/asp
- FDA Drug Shortages Database — current and resolved drug shortage tracking. accessdata.fda.gov/drugshortages