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Overview: Levorphanol is an opioid pain medicine that is used to treat severe pain. It works on receptors in the body to help keep you from feeling pain. Common side effects include constipation, nausea, vomiting, sleepiness, or dizziness. Talk to your health care provider right away if you develop confusion or shortness of breath, have trouble staying awake, or feel like your pain is getting worse instead of better. Before taking levorphanol, make sure to tell your health care provider about any health conditions you have or medicines you are taking.

Uses

What is levorphanol used for?

Levorphanol is an opioid pain medicine commonly used to treat severe pain.

Levorphanol may also be used for other conditions as determined by your health care provider.

How does levorphanol work (mechanism of action)?

Levorphanol works on receptors in the body to help keep you from feeling pain by altering how your body feels and responds to pain.

How is levorphanol supplied (dosage forms)?

Brands and other names

  • Levo-Dromoran

Dosage forms and strengths

  • 2 mg oral tablets
  • 3 mg oral tablets

How should I store levorphanol?

Levorphanol should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of levorphanol?

The most common side effects of levorphanol are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Constipation (see below)
  • Nausea or vomiting
  • Sleepiness or tiredness
  • Headache
  • Dizziness 
  • Stomach pain

There may be other side effects of levorphanol that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of levorphanol?

While less common, the most serious side effects of levorphanol are described below, along with what to do if they happen.

Severe Allergic Reactions. Levorphanol may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Risk of Misuse and Addiction. Misusing levorphanol can lead to serious side effects like coma or death. Misuse means taking a medicine in a way other than how it was prescribed. Take levorphanol exactly as prescribed. Tell your health care provider if you feel that levorphanol is not working. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures

Breathing Problems. Levorphanol may cause slow or shallow breathing, especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Tell your health care provider if you develop severe sleepiness or trouble breathing, especially when you start levorphanol or when your dose is increased. Get emergency help if you have any of the following symptoms.

  • Changes in the color of your skin, including a bluish color to your lips and fingernails
  • Confusion
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
  • Slow or shallow breathing
  • Excessive sleepiness or trouble staying awake

Constipation. Some people taking levorphanol have had severe constipation. Some needed to go to the hospital. Get help right away if you have severe constipation. 

Sphincter of Oddi Spasm. The sphincter of Oddi is a muscular valve in your body that controls the flow of bile and digestive juices from the pancreas into the small intestine. When this valve spasms, it may feel like getting a tight muscle cramp, causing pain and blocking the flow of these juices, which can lead to discomfort and digestive problems. This is more likely to happen if you do not have a gallbladder. Get emergency help if you have new or worse stomach pain or pain in the upper right side of your stomach area that travels to your back or shoulder, with or without nausea and vomiting. 

Low Blood Pressure (Hypotension). Levorphanol may cause low blood pressure. If you feel faint or dizzy, lie down. Tell your health care provider right away if you have any of the following symptoms of low blood pressure.

  • Dizziness, feeling lightheaded, or fainting
  • Confusion
  • Feeling weak or tired

Increased Pain and Pain Sensitivity. Levorphanol may cause allodynia, which is when you have pain from something that normally does not cause pain, such as brushing your hair. Levorphanol may also cause hyperalgesia, which is when you are very sensitive to pain. Contact your health care provider right away if you have pain from things that did not cause pain before, worsening pain, or more pain sensitivity. Do not use more levorphanol if your pain feels worse as this may cause serious side effects. 

Reduced Adrenal Function. Long-term use of levorphanol can cause your body’s adrenal glands to stop making as much cortisol (the stress hormone). This is known as adrenal insufficiency. Adrenal insufficiency can get worse if your body is under stress because of fever, surgery, or trauma. Tell your health care provider if you have any of the following symptoms of adrenal insufficiency.

  • Nausea and vomiting
  • Weakness, tiredness, or lack of energy
  • Low blood pressure

Warnings & Precautions

Who should not use levorphanol?

Allergies to Ingredients. People who are allergic to any of the following should not take levorphanol.

  • Levo-Dromoran
  • Levorphanol
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific levorphanol products they stock.

Lung Problems. Levorphanol should not be used if you have severe asthma, trouble breathing, or other lung problems. Levorphanol can make these conditions worse.

Gut Blockage. Levorphanol should not be used if you have a blockage of your gut (bowel obstruction) or a narrowing of the stomach or intestines. Levorphanol can make these conditions worse.

Slowed Gut Movement. Paralytic ileus is a type of ileus where your intestines are unable to move food through them. Levorphanol can make this condition worse.

What should I know about levorphanol before using it?

Do not take levorphanol unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not share levorphanol with other people, even if they have the same condition as you. It may harm them.

Keep levorphanol out of the reach of children. Levorphanol is a controlled substance because it can be misused or lead to dependence. Store levorphanol in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

Levorphanol can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how levorphanol affects you.

People who are 65 or older can be at greater risk for some side effects from levorphanol. Talk to your health care provider about your risks if you are in this age group.

Long-term use of levorphanol may affect your ability to become pregnant or get a partner pregnant. Talk to your health care provider if you have any concerns.

If you have been taking levorphanol on a regular basis, do not stop taking the medicine without talking to your health care provider. Stopping levorphanol too quickly can cause serious withdrawal effects. Call your health care provider right away if you have any of the following symptoms.

  • Feeling restless
  • Watery eyes or runny nose
  • Yawning
  • Sweating or chills
  • Muscle, joint, or back pain
  • Dilated pupils 
  • Irritability, anxiety, or trouble sleeping
  • Nausea, vomiting, diarrhea, stomach cramps, or loss of appetite
  • Increase in blood pressure, breathing rate, or heart rate

Your health care provider may ask you to have naloxone, a medicine used to reverse the effects of levorphanol, on hand in case of an emergency. Make sure that you and a caregiver know how to use naloxone. If you have any questions, talk to your health care provider or pharmacist.

Dispose of expired, unwanted, or unused levorphanol right away by taking your medicine to an authorized DEA-registered collector or a drug take-back program. If one is not available, you can flush levorphanol down the toilet.

What should I tell my health care provider before using levorphanol?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if levorphanol is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following. 

  • Head injury or brain problems, such as brain tumors or increased pressure around the brain
  • Seizures
  • Liver, kidney, or thyroid problems
  • Pancreas or gallbladder problems
  • Breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD)
  • Sleep apnea
  • Heart problems
  • Problems peeing 
  • Substance use disorder or living with someone who has this problem
  • Alcohol use disorder
  • History of opioid overdose
  • Mental health problems

Other Medicines and Supplements. Levorphanol may interact with other medicines and supplements. Before taking levorphanol, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Levorphanol may cause harm to a fetus. Tell your health care provider if you are pregnant or plan to become pregnant. Your health care provider will let you know if you should take levorphanol while you are pregnant or trying to get pregnant. If you take levorphanol on a regular basis during pregnancy, your baby may have withdrawal symptoms that can be life-threatening. Tell your health care provider if you took levorphanol during your pregnancy, especially near the end of your pregnancy.

Breastfeeding. Levorphanol passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop levorphanol. Tell your health care provider right away if your baby is sleepier than usual and get emergency help if your baby is having trouble breathing or is limp.

Interactions

Does levorphanol interact with foods or drinks?

There are no known interactions between levorphanol and foods or nonalcoholic drinks.

Do not drink alcohol or use prescription or over-the-counter medicines that contain alcohol. Using alcohol while taking levorphanol can increase your risk of overdose and death.

Does levorphanol interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking levorphanol.

  • A benzodiazepine, such as clonazepam (Klonopin), diazepam (Valium and others), or lorazepam (Ativan and others), which is a medicine used for anxiety, muscle spasms, or seizures
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, muscle relaxants, and medicines for anxiety
  • Any medicine that affects serotonin in your body, such as medicines for depression, anxiety, or certain mental health conditions; some migraine medicines; and some medicines for nausea and vomiting 
  • A mixed agonist/antagonist or partial agonist opioid analgesic, such as buprenorphine (Butrans, Sublocade), butorphanol, and others, which is a medicine used to treat certain types of pain or opioid use disorder
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems

This may not be a complete list of medicines that can interact with levorphanol. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much levorphanol?

If you or someone else has used too much levorphanol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of levorphanol?

If you miss a dose, skip the missed dose and only take the next dose at your usual time. Do not take double or extra doses.