Risk Factor: D
Class: Central nervous system drugs/ Narcotic antagonists
Fetal Risk Summary
Levallorphan is a narcotic antagonist that is used to reverse respiratory depression from narcotic overdose. It has been used in combination with alphaprodine or meperidine during labor to reduce neonatal depression (1,2,3,4,5 and 6). Although some benefits were initially claimed, caution in the use of levallorphan during labor has been advised for the following reasons (7): a.
statistically significant reduction in neonatal depression has not been demonstrated; b.
the antagonist also reduces analgesia; c.
the antagonist may increase neonatal depression if an improper narcotic-narcotic antagonist ratio is used.
As indicated above, levallorphan may cause respiratory depression in the absence of narcotics or if a critical ratio is exceeded (7). Because of these considerations, the use in pregnancy of levallorphan either alone or in combination therapy should be discouraged. If a narcotic antagonist is indicated, other agents that do not cause respiratory depression, such as naloxone, are preferred.
Breast Feeding Summary
No data are available.
- Backner DD, Foldes FF, Gordon EH. The combined use of alphaprodine (Nisentil) hydrochloride and levallorphan tartrate for analgesia in obstetrics. Am J Obstet Gynecol 1957;74:27182.
- Roberts H, Kuck MAC. Use of alphaprodine and levallorphan during labour. Can Med Assoc J 1960;83:108893.
- Roberts H, Kane KM, Percival N, Snow P, Please NW. Effects of some analgesic drugs used in childbirth. Lancet 1957;1:12832.
- Bullough J. Use of premixed pethidine and antagonists in obstetrical analgesia with special Reference to cases in which levallorphan was used. Br Med J 1959;2:85962.
- Posner AC. Combined pethidine and antagonists in obstetrics. Br Med J 1960;1:1245.
- Bullough J. Combined pethidine and antagonists in obstetrics. Br Med J 1960;1:125.
- Bonica JJ. Principles and Practice of Obstetric Analgesia and Anesthesia. Philadelphia, PA:FA Davis, 1967;2549.