It is primarily used in the treatment of acute headaches. Butorphanol, regardless of the route, is not recommended for use in cancer pain treatment. Subcutaneous or intravenous continuous infusions may benefit patients with persistent nausea or vomiting, dysphagia or difficulty swallowing, intestinal obstruction, malabsorption, analgesic requirements which make oral dosing impractical, as well as patients who require rapid titration of opioids. Medications may be given as repeated intermittent bolus doses or by continuous infusion. Bolus IV dosing provides a shorter duration of action than other routes.
Continuous infusions provide steady blood levels.
The use of an infusion pump may be the best strategy for delivery of a continuous infusion. It is recommended that the hourly SQ volume limit not exceed 5 cc. Intravenous and subcutaneous infusions can be administered at home provided that the caregiver received appropriate instruction. The subcutaneous site should be inspected and possibly be rotated every 48-72 hrs in neutropenic patients to minimize risk of site infection. Intramuscular injections should be avoided because injections are painful and inconvenient, and absorption is erratic.