levorphanol

• Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health problems

Levorphanol is a controlled substance because it has a risk for addiction and misuse. Take the medication exactly as prescribed. Don't change the dose or how often you take it without talking to your provider first. Misusing this medication might cause it to not work as well. It can also raise the risk for serious and possibly life-threatening side effects, such as dangerously slow breathing, inability to stay awake, and opioid overdose. Your healthcare provider will prescribe the lowest amount of levorphanol that's necessary to manage your pain for the shortest period of time possible.

• Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Older age | Being frail | Medical conditions that cause breathing problems (e.g., COPD, asthma, head injury) | Taking too much levorphanol

Levorphanol can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone and even at recommended doses. But the risk is greatest when you first start treatment or if your dose goes up. Don't take levorphanol with alcohol or other medications that slow your body down (e.g., benzodiazepines, other opioids, muscle relaxants). Doing so raises your risk of extremely slowed breathing. If you or your loved one notices that you have trouble breathing or have bluish-colored lips, fingers, or toes, call 911 to get medical help right away.

• Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of levorphanol | Taking more opioids than prescribed | Alcohol use

Take levorphanol exactly as prescribed. Taking too much levorphanol or taking it more often than prescribed can lead to an accidental overdose. Symptoms of an opioid overdose include not responding to sound or touch, extremely slowed breathing, extreme sleepiness, slow heartbeat, and cold or clammy skin. Be sure you and your loved ones know how to recognize an overdose. Your provider will likely prescribe naloxone (Narcan, Zimhi), an opioid antagonist that can treat an opioid overdose. Make sure you carry naloxone with you at all times in case you experience an overdose. Call 911 right away if this happens. Store your medication out of reach from children, pets, or visitors to prevent accidental exposure or overdose.

• Risk factors: Taking high doses of levorphanol | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness | Liver problems

Levorphanol can cause extreme sleepiness and lower your ability to think, react, and focus. Don't drink alcohol or take other medications that can cause sleepiness or "brain fog" (e.g., benzodiazepines, muscle relaxants, sleep medications) with levorphanol. Doing so can worsen these side effects. Make sure you know how levorphanol affects you before driving a car or doing activities where you need to focus. Talk to your healthcare provider right away if you feel too sleepy from taking levorphanol.

Long-term use of levorphanol during pregnancy can cause your unborn baby to become dependent on the medication. This is because opioids like levorphanol can pass through the placenta to your unborn baby. Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding and sucking behavior, trembling, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare provider know if you've used levorphanol during pregnancy or if you notice these symptoms in your baby.

• Risk factors: Long-term use of levorphanol

If taken regularly for a long time, levorphanol can cause physical dependence. This means that your body relies on the medication to function. You might experience withdrawal if you stop taking the medication suddenly. Withdrawal symptoms include anxiety, restlessness, irritability, runny nose, yawning, sweating, and chills. Don't lower your dose or stop taking the medication suddenly without talking to your healthcare provider first. Your provider will slowly lower your dose to prevent withdrawal symptoms. If you have concerns about taking levorphanol because of this risk, talk to your healthcare provider about alternative pain medications.

• Risk factors: History of low blood pressure | Unstable blood pressure | Taking certain medications that can slow the body down

Levorphanol can cause extremely low blood pressure. Your blood pressure might drop suddenly when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your healthcare provider.

• Risk factors: Taking levorphanol for longer than 1 month

Some people taking opioids like levorphanol experienced low adrenal hormone levels. This might be more likely to happen after taking opioids for longer than 1 month. Symptoms include tiredness, dizziness, weakness, not feeling hungry, nausea, and vomiting. Let your provider know if you experience these symptoms. If your adrenal hormone levels are too low, you might need to stop levorphanol and be treated with corticosteroids.

• Risk factors: History of seizure conditions

If you've had a seizure in the past, opioids can raise the risk of having seizures more often. Levorphanol can also raise your risk of seizures in certain situations. Get medical help right away if you have a seizure while taking levorphanol.

Levorphanol can interact with medications, which can raise your risk of side effects or affect how well your medications work for you.

Though rare, taking levorphanol with other medications that raise serotonin levels (e.g., antidepressants, migraine medications) can raise your risk of a potentially life-threatening condition called serotonin syndrome. This condition happens when there's too much of a chemical called serotonin in the brain. Get medical help if you experience symptoms of serotonin syndrome, such as fast heart rate, muscle stiffness or spasms, fever, and confusion.

Sometimes, opioids like levorphanol can affect how well diuretics ("water pills") work to lower blood pressure or swelling due to fluid buildup in the body. If you need to take a diuretic at the same time as levorphanol, let your provider know if you experience worsening swelling or higher blood pressure than usual.

Tell your provider and pharmacist about all your prescriptions and over-the-counter products you take before starting levorphanol. They can check for any drug interactions.