May cause CNS depression. May cause hypotension (caution in hypovolemia, cardiovascular disease, or drugs which may exaggerate hypotensive effects). May obscure diagnosis or clinical course of acute abdominal conditions. Use with caution in adrenal insufficiency, including Addison’s disease. Use with caution in biliary tract dysfunction. Use with caution in history of drug abuse or acute alcoholism (risk of drug dependency; tolerance, psychological and physical dependence may occur). Use with extreme caution in head injury, intracranial lesions, or elevated intracranial pressure (may elevate intracranial pressure). Use with caution in hepatic and renal impairment. Use with caution in prostatic hyperplasia and/or urinary stricture. Use with caution in morbidly obese patients. Use with caution in pre-existing respiratory compromise (hypoxia and/or hypercapnia), COPD or other obstructive pulmonary disease, and kyphoscoliosis or other skeletal disorder which may alter respiratory function (critical respiratory depression may occur). Use with caution in thyroid dysfunction. Concurrent use of sumatriptan nasal spray and butorphanol nasal spray may increase risk of transient high blood pressure. Use with caution in debilitated patients (risk of critical respiratory depression). Caution in the elderly (higher sensitivity to adverse effects). Concurrent use of agonist/antagonist analgesics may precipitate withdrawal symptoms and/or reduced analgesic efficacy following prolonged therapy with µ-opioid agonists. Abrupt discontinuation following prolonged use may also lead to withdrawal symptoms. Episodes of abuse associated with all routes of administration, especially nasal administration. Use with caution in patients who recently received repeated doses of opiate analgesics. Possible increased myocardial workload (use in patients with acute myocardial infarction, ventricular dysfunction, or coronary insufficiency only if the potential benefits justify the possible risks). Severe hypertension reported rarely. Use cautiously before surgery or anesthesia in hypertensive patients. Possible hypotension associated with syncope in patients receiving nasal solution.