Stadol (Butorphanol) at a glance: schedule, half-life, and class
- Generic name
- Butorphanol tartrate
- Brand names
- Stadol NS (discontinued brand); generic nasal spray and injection
- Drug class
- Mixed opioid agonist-antagonist
- US legal status
- Schedule IV, prescription only (since 1997)
- Approved uses
- Pain severe enough to require an opioid; pain during labor and before surgery (injection)
- Forms
- Nasal spray (1 mg per spray), injection
- Onset
- About 15 minutes (nasal)
- Half-life
- About 5 to 6 hours
- Reversal agent
- Naloxone
Stadol uses: what butorphanol is prescribed for
Butorphanol is approved for pain severe enough to require an opioid. The injection is used in labor and before surgery, and the nasal spray for acute pain, including, off-label, migraine attacks.[1]
As a mixed agonist-antagonist, its effect on breathing levels off at higher doses, but it still causes sedation and can cause dangerous slowed breathing, especially with other depressants.[1]
Stadol dosage: how butorphanol is usually prescribed
The figures below come from the FDA-approved label and describe how prescribers typically use butorphanol. They are not personal dosing advice. A prescriber sets the dose for each person and adjusts it over time.[1]
| Product | Typical adult dose | Notes from the label |
|---|---|---|
| Nasal spray, adults | 1 mg (one spray in one nostril) | A second dose may be given after 60 to 90 minutes if needed |
| Repeat dosing | The two-dose sequence may be repeated every 3 to 4 hours | Use only as long as needed |
| Older adults, liver or kidney impairment | Start with 1 mg and wait 90 to 120 minutes before a second dose | Longer intervals between doses |
Stadol (butorphanol) side effects and risks
FDA boxed warnings
- Addiction, abuse, and misuse, which can lead to overdose and death.
- Life-threatening slowed breathing, especially when starting treatment or after a dose increase.
- Accidental ingestion, especially by children, can cause a fatal overdose.
- Use with benzodiazepines or other central nervous system depressants, including alcohol, can cause profound sedation, slowed breathing, coma, and death.[2]
- Prolonged use during pregnancy can cause neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated.
Common side effects include drowsiness, dizziness, nausea, nasal congestion, and unpleasant mood effects such as anxiety or feeling detached.[1]
Rebound headache and dependence: frequent use for migraine can lead to more frequent headaches, dependence, and misuse.[1]
Withdrawal in opioid users: because it partly blocks mu receptors, butorphanol can cause sudden withdrawal in people dependent on other opioids.[1]
Stadol interactions: what not to mix with butorphanol
Choose what it would be combined with:
| Combined with | What happens | Label guidance |
|---|---|---|
| Benzodiazepines (alprazolam, diazepam, clonazepam) | Profound sedation, slowed breathing, coma, death | Boxed warning; avoid unless no alternative |
| Alcohol | Stronger sedation and slowed breathing | Avoid |
| Gabapentin, pregabalin, sleep medicines, muscle relaxants | Additive sedation and breathing problems | Use caution; lower doses |
| Full opioid agonists in dependent patients | Sudden withdrawal; reduced pain relief | Avoid |
| Nasal decongestant sprays (oxymetazoline) | Slower absorption of butorphanol | Be aware |
This is not a full list. A pharmacist can check a complete medication list, including supplements and over-the-counter products.[1]
Stadol overdose: signs of butorphanol overdose and what to do
Butorphanol overdose causes extreme sleepiness, confusion, slow breathing, and low blood pressure, especially combined with alcohol or sedatives.[1][3]
If someone may have overdosed
- Call 911 if the person is unresponsive, cannot be woken, has blue or gray lips, or is breathing slowly or not at all.
- Give naloxone (Narcan or a generic nasal spray, sold without a prescription) into one nostril. If there is no response after 2 to 3 minutes, give another dose.
- If you are trained, give rescue breaths. Otherwise place the person on their side so they do not choke.
- Stay with them. Naloxone can wear off before butorphanol does, so the overdose can return even after the person wakes up.
- Most states have Good Samaritan laws that protect people who call 911 for an overdose from some drug charges.
Stadol withdrawal timeline: how long butorphanol withdrawal lasts
People who take butorphanol regularly for more than a few weeks become physically dependent, even when they take it exactly as prescribed. Dependence is not the same as addiction, but it means stopping suddenly causes withdrawal.[1]
- 12 to 24 hoursEarly symptomsAnxiety, restlessness, yawning, sweating, runny nose, watery eyes, and muscle aches.
- Days 2 to 4Peak withdrawalDiarrhea, stomach cramps, nausea and vomiting, goosebumps, dilated pupils, fast heartbeat, and strong cravings. Rarely dangerous in healthy adults, but dehydration can be serious.
- 1 to 2 weeksLingering symptomsPoor sleep, low mood, low energy, and cravings can continue for weeks. Tolerance falls quickly, which raises the risk of overdose if use restarts.
Warning: After a break, the body loses tolerance within days. Returning to a previous dose of butorphanol can cause a fatal overdose.
The FDA warns against stopping opioids abruptly in people who are physically dependent. A prescriber can taper the dose gradually, often by 10% or less per month for long-term users, and medicines such as clonidine or lofexidine can ease symptoms. For opioid use disorder, buprenorphine and methadone cut the risk of death roughly in half.[4]
How to get prescribed Stadol (butorphanol) legally in the US
In the United States, butorphanol is a Schedule IV controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.[5]
- Refills: a Schedule IV prescription can be refilled up to five times within six months of the date it was written. After that, a new prescription is needed.[6]
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.[7]
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
- Pharmacies: a legitimate pharmacy always requires a valid prescription, has a licensed pharmacist available, and is licensed in the state it ships to. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm a pharmacy is real.[8][9]
- Cost: generic butorphanol nasal spray is moderately priced; insurance often limits quantities.
Traveling: keep the medicine in its original pharmacy container and carry a copy of the prescription. Check the rules of the destination country before travel, because many countries restrict controlled medicines or require a permit.
Can you order Stadol (butorphanol) online legally?
Yes, but only with a valid prescription and only from a pharmacy licensed in your state. Many licensed pharmacies, including mail-order pharmacies run by insurers, fill butorphanol prescriptions online and ship them. Buying butorphanol from a website that does not require a prescription is illegal, and the product is often fake.[8][10]
- See a licensed clinicianA clinician evaluates you in person or by telemedicine and decides whether butorphanol is appropriate.
- The prescription goes to a pharmacyPrescriptions are usually sent electronically, straight from the prescriber to the pharmacy you choose.
- The pharmacy checks and fills itA pharmacist verifies the prescription and your identity, then dispenses the medicine in person or by mail.
Signs that an online seller is illegal:
- It sells butorphanol with no prescription, or after only a short online questionnaire.
- It takes orders through social media, messaging apps, or email.
- It asks for payment in cryptocurrency, gift cards, or money transfers.
- It has no US street address, no state pharmacy license, and no pharmacist to speak to.
- Its prices are far below those of ordinary pharmacies, or it ships from another country.
The FDA's BeSafeRx tool links to each state's license lookup, and the National Association of Boards of Pharmacy lists verified online pharmacies.[8][9]
Stadol price: how much does Stadol (butorphanol) cost without insurance?
Generic butorphanol nasal spray is moderately priced; insurance often limits quantities.
What you pay depends on the strength, the number of doses, your insurance plan, and the pharmacy. Cash prices for the same prescription can differ several times over between pharmacies in the same town, so check current prices before you fill it.
Ways to pay less, legally:
- Ask the prescriber whether a generic butorphanol is available. FDA-approved generics work the same way as the brand and usually cost much less.
- Compare cash prices between pharmacies before you fill the prescription.
- Use a free prescription discount card, such as GoodRx or SingleCare, when you pay cash. These cards cannot be combined with insurance on the same fill.
- For brand-name medicines, check the manufacturer's savings program or patient assistance program.
- Ask about a 90-day supply or your insurer's mail-order pharmacy, which often lowers the cost per dose when your prescriber agrees it is appropriate.
Warning: A price far below what licensed pharmacies charge, especially with no prescription required, is a strong sign of an illegal seller and counterfeit medicine.[8]
Is Stadol legal? Butorphanol legal status in other countries
| Country | Status |
|---|---|
| International | Not under UN control; controlled nationally in some countries |
Laws change and differ in detail. Check current rules before carrying any controlled medicine across a border.[11]
Common questions about Stadol (butorphanol)
Is Stadol (butorphanol) an opioid?
Yes. It is a mixed agonist-antagonist opioid and a Schedule IV controlled substance.
Is Stadol (butorphanol) good for migraine?
It can relieve migraine pain, but guidelines discourage opioids for migraine because of rebound headaches and dependence.
Can Stadol (butorphanol) be taken with oxycodone?
No. It can block other opioids and cause withdrawal.
Is Stadol (butorphanol) used in animals?
Yes. It is widely used as a sedative and pain reliever in veterinary medicine.
How long does Stadol (butorphanol) last?
Pain relief from the nasal spray usually lasts 3 to 5 hours.
Can you buy Stadol (butorphanol) without a prescription?
No. Stadol (butorphanol) is a Schedule IV controlled substance in the US, so it is illegal to buy or possess it without a valid prescription. Websites and social media sellers that offer it without one are not legal pharmacies, and the DEA warns that pills sold this way are often counterfeit and can contain fentanyl. The legal route is a visit with a licensed clinician, in person or by telehealth, and a prescription filled at a state-licensed pharmacy. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm an online pharmacy is real.
Sources
- butorphanol prescribing information. DailyMed, US National Library of Medicine.
- FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines. US Food and Drug Administration, 2016.
- Information about naloxone and nalmefene. US Food and Drug Administration.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022. Centers for Disease Control and Prevention, MMWR.
- Controlled Substance Schedules. DEA Diversion Control Division.
- 21 CFR 1306.22, Refilling of prescriptions (Schedules III and IV). Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth. US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information. US Food and Drug Administration.
- Safe Pharmacy. National Association of Boards of Pharmacy.
- One Pill Can Kill. US Drug Enforcement Administration.
- International drug control conventions. United Nations Office on Drugs and Crime.
