When This Medicine Should Not Be Used:
You should not use this medicine if you have ever had an allergic reaction to butorphanol.

How to Use This Medicine:
Spray

• Your doctor will tell you how much to use and how often.
• Blow your nose gently to clear the nostrils.
• Take the cap off of the bottle and remove the clip from the neck of the pump.
• If you are using the medicine for the first time, you will need to prime the spray pump.
• To do this, hold the spray bottle with your thumb on the bottom of the bottle and your index and middle fingers on the 2 flaps on the side of the pump.
• Push down with your index and middle fingers. Keep pumping until you see the medicine spray from the bottle.
• Put the tip of the spray pump into your nostril.
• Close the other nostril with your finger and lean your head slightly forward.
• Sniff gently and push down on the 2 flaps to spray the medicine into your nose. Keep your mouth closed as you are breathing in.
• Take the spray pump out of your nostril and tilt your head back. Sniff a few more times.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are taking cimetidine (Tagamet®, erythromycin, theophylline, other nasal sprays (such as Afrin® or Dristan®), or any drug that could make you sleepy such as sleeping pills, cold and allergy medicine, muscle relaxants, or narcotic pain killers.
• Avoid drinking alcohol while you are using this medicine.

Warnings While Using This Medicine:

• Check with your doctor before taking butorphanol if you have asthma, liver, kidney, or heart disease; a history of drug abuse; any lung problems.
• If you are pregnant or breastfeeding, talk to your doctor before taking this medicine.
• This medicine may make you drowsy or dizzy. Be careful if you are driving a car or using machinery.
• This medicine may be habit-forming. You should not use more of it than your doctor ordered.
• This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Fast or irregular heartbeat
• Trouble breathing
• Confusion or hallucinations
• Trouble urinating
• Seizures

If you notice these less serious side effects, talk with your doctor:

• Drowsiness or dizziness
• Nausea or vomiting
• Nasal congestion
• Constipation
• Trouble sleeping
• Ringing in the ears
• Bad taste in the mouth
• Blurred vision

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088