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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]" /><meta name="citation_title" content="Butorphanol" /><meta name="citation_publisher" content="National Institute of Child Health and Human Development" /><meta name="citation_date" content="2025/02/15" /><meta name="citation_pmid" content="30000262" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK501203/" /><meta name="citation_keywords" content="butorphanol" /><meta name="citation_keywords" content="Butorfanol" /><meta name="citation_keywords" content="Butorphanolum" /><meta name="citation_keywords" content="levo-BC-2627" /><meta name="citation_keywords" content="UNII-QV897JC36D" /><meta name="citation_keywords" content="l-BC 2627" /><meta name="citation_keywords" content="QV897JC36D" /><meta name="citation_keywords" content="DEA No. 9720" /><meta name="citation_keywords" content="EINECS 255-808-8" /><meta name="citation_keywords" content="(1S,9R,10S)-17-(cyclobutylmethyl)-17-azatetracyclo[7.5.3.01,10.02,7]heptadeca-2(7),3,5-triene-4,10-diol" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Butorphanol" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Child Health and Human Development" /><meta name="DC.Date" content="2025/02/15" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK501203/" /><meta name="description" content="Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Limited data indicate that butorphanol is excreted into breastmilk in small amounts. Butorphanol is poorly orally absorbed, so it is unlikely to adversely affect the breastfed infant. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If butorphanol is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake to 2 to 3 days with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Labor pain medication may delay the onset of lactation. 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If butorphanol is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake to 2 to 3 days with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Labor pain medication may delay the onset of lactation. Because there is no published experience with repeated, high intravenous or intranasal doses of butorphanol during breastfeeding, other agents may be preferred in these situations, especially while nursing a newborn or preterm infant" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK501203/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-lactmed-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/lactmed/LM339/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK501203/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK501203_"><span class="title" itemprop="name">Butorphanol</span></h1><p class="small">Last Revision: <span itemprop="dateModified">February 15, 2025</span>.</p><p><em>Estimated reading time: 3 minutes</em></p></div><div class="body-content whole_rhythm" itemprop="text"><p>CASRN: 42408-82-2</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/135000864" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135000864" alt="image 135000864 in the ncbi pubchem database" /></a><div id="LM339.Drug_Levels_and_Effects"><h2 id="_LM339_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM339.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Limited data indicate that butorphanol is excreted into breastmilk in small amounts. Butorphanol is poorly orally absorbed, so it is unlikely to adversely affect the breastfed infant. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If butorphanol is required by the mother of a newborn, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake to 2 to 3 days with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Labor pain medication may delay the onset of lactation. Because there is no published experience with repeated, high intravenous or intranasal doses of butorphanol during breastfeeding, other agents may be preferred in these situations, especially while nursing a newborn or preterm infant</p></div><div id="LM339.Drug_Levels"><h3>Drug Levels</h3><p>In adults, the oral bioavailability of butorphanol is 17% while the intranasal bioavailability is 70%. Butorphanol is metabolized to inactive metabolites. Intranasal and parenteral doses of 25 to 30 mcg/kg have been used in infants as young as 6 months for postoperative analgesia.</p><p><i>Maternal Levels.</i> Twelve lactating women were given a single butorphanol dose at 2 to 4 days postpartum. Six of these women were given a 2 mg single intramuscular dose and 6 others were given a single 8 mg oral dose. Milk was sampled 3 times after the dose. The reported average milk levels were 1.5, 0.7 and 0.3 mcg/L at 2, 4 and 8 hours, respectively, after the 2 mg intramuscular dose. The average milk levels after the 8 mg oral dose were 3.6, 1.8 and 1.1 mcg/L at 3, 5 and 8 hours, respectively. The half-life of elimination from milk was about 2 hours.[<a class="bk_pop" href="#LM339.REF.1">1</a>] Using the data from this study, doses of butorphanol 2 mg intramuscularly or 8 mg orally will result in average milk levels of 0.7 and 2 mcg/L, respectively, over 8 hours after the dose. Using these calculated average milk levels, an exclusively breastfed infant would receive 0.035 mcg/kg from a 2 mg intramuscular maternal dose of butorphanol, and 0.1 mcg/kg from an 8 mg oral maternal dose of butorphanol, from milk ingested up through 8 hours after the dose. These amounts represent 0.11% and 0.08% of the maternal weight-adjusted dosages, respectively.</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM339.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM339.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Narcotics and narcotic agonist-antagonists can increase serum prolactin.[<a class="bk_pop" href="#LM339.REF.2">2</a>,<a class="bk_pop" href="#LM339.REF.3">3</a>] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.</p><p>A study compared women who received butorphanol or nalbuphine during labor (n = 26) to those who received no analgesia (n = 22). The time to effective breastfeeding was longer (46.5 minutes) in the analgesia group than in the no analgesia group (35.4 minutes).[<a class="bk_pop" href="#LM339.REF.4">4</a>]</p><p>A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.[<a class="bk_pop" href="#LM339.REF.5">5</a>]</p><p>A double-blind study compared women undergoing cesarean section with combined spinal-epidural anesthesia. Women received either intranasal saline, 1 mg of intranasal butorphanol after delivery of the infant or 5 mg of intravenous butorphanol by PCA pump after closure of the abdomen. All patients received 1.5 mcg/kg of sufentanil and 10 mg tropisetron intravenously by PCA pump after delivery. No significant differences among the 3 groups on the time to initiation of lactation (26 to 27 hours) and no significant differences in prolactin levels pre- and postoperatively.[<a class="bk_pop" href="#LM339.REF.6">6</a>]</p></div><div id="LM339.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/n/lactmed/LM330/">Acetaminophen</a>, <a href="/books/n/lactmed/LM360/">Hydromorphone</a>, <a href="/books/n/lactmed/LM142/">Ibuprofen</a>, <a href="/books/n/lactmed/LM370/">Morphine</a>, <a href="/books/n/lactmed/LM371/">Nalbuphine</a></p></div><div id="LM339.References"><h3>References</h3><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="LM339.REF.1">Pittman
|
||
KA, Smyth
|
||
RD, Losada
|
||
M, et al.
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||
Human perinatal distribution of butorphanol.
|
||
Am J Obstet Gynecol
|
||
1980;138:797-800.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/7446613" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7446613</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="LM339.REF.2">Tolis
|
||
G, Dent
|
||
R, Guyda
|
||
H. Opiates, prolactin, and the dopamine receptor.
|
||
J Clin Endocrinol Metab
|
||
1978;47:200-3.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/263291" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 263291</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="LM339.REF.3">Saarialho-Kere
|
||
U.
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||
Psychomotor, respiratory and neuroendocrinological effects of nalbuphine and haloperidol, alone and in combination, in healthy subjects.
|
||
Br J Clin Pharmacol
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||
1988;26:79-87.
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||
[<a href="/pmc/articles/PMC1386503/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1386503</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/3060191" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3060191</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="LM339.REF.4">Crowell
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MK, Hill
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||
PD, Humenick
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||
SS. Relationship between obstetric analgesia and time of effective breast feeding.
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||
J Nurse Midwifery
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||
1994;39:150-6.
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||
[<a href="https://pubmed.ncbi.nlm.nih.gov/7931694" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7931694</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="LM339.REF.5">Lind
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JN, Perrine
|
||
CG, Li
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||
R. Relationship between use of labor pain medications and delayed onset of lactation.
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J Hum Lact
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2014;30:167-73.
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||
[<a href="/pmc/articles/PMC4684175/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4684175</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24451212" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24451212</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="LM339.REF.6">Zeng
|
||
J, Sun
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||
X, Luo
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||
M, et al.
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||
Butorphanol tartrate nasal spray for post-cesarean analgesia and prolactin secretion.
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||
Med Sci Monit
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||
2025;31:e945224.
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[<a href="/pmc/articles/PMC11760558/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC11760558</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/39834057" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 39834057</span></a>]</div></dd></dl></div></div><div id="LM339.Substance_Identification"><h2 id="_LM339_Substance_Identification_">Substance Identification</h2><div id="LM339.Substance_Name"><h3>Substance Name</h3><p>Butorphanol</p></div><div id="LM339.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>42408-82-2</p></div><div id="LM339.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Analgesics, Opioid</p><p>Narcotics</p><p>Narcotic Antagonists</p><p>Opiates</p></div></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div><div class="small"><span class="label">Bookshelf ID: NBK501203</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/30000262" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">30000262</a></span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/lactmed/">Contents</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/lactmed/LM543/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/lactmed/LM969/" title="Next page in this title">Next ></a></div></div></div></div>
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