Levorphanol
Levorphanol is a strong opioid pain medicine used for pain that is severe enough to need an opioid and that other treatments have not controlled.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 8 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Levorphanol is a strong opioid pain medicine that acts on opioid receptors in the brain and spinal cord, an older, less often prescribed option (on the market since about 1953 and available as a generic) reserved for severe pain other treatments have not controlled. It is tolerated much like other strong opioids, with dizziness, nausea and itching most noticeable early and constipation that tends to persist. Its boxed warning covers addiction, misuse and life-threatening slowed breathing that can lead to fatal overdose, a risk highest when starting or raising the dose and far greater with alcohol or sedating medicines.
Clinical pearls
- It stays in the body long after each dose, so sleepiness can build for days; never take doses early.
- Gabapentin, pregabalin and muscle relaxants like cyclobenzaprine add to its sedation, so mention them even if they seem harmless.
- Antidepressants, triptans, tramadol and linezolid can trigger serotonin syndrome (a dangerous serotonin overload) with levorphanol, so every prescriber should know.
- Keep naloxone (an overdose reversal medicine) at home and lock up tablets, since one dose can kill a child.
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾
Levorphanol can cause addiction, life-threatening slowed breathing, and fatal overdose, especially if taken with alcohol or sedating medicines.
- Addiction and misuse: This can happen to anyone, and can lead to overdose and death. Your prescriber should assess your risk and monitor you.
- REMS program: The FDA requires a safety program for opioid pain medicines, so expect counseling on safe use, storage and disposal.
- Slowed breathing: Risk is highest when starting or increasing the dose.
- Accidental ingestion: Even one dose can be fatal for a child.
- Pregnancy: Prolonged use can cause life-threatening withdrawal in a newborn.
- Alcohol and sedatives: Combining them with benzodiazepines or other CNS depressants can cause profound sleepiness, breathing problems, coma and death.
Patient information guide A plain-language walkthrough of Levorphanol, written from its FDA label.
What Levorphanol is used for
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Levorphanol is an opioid pain medicine with one supported use.
- Levorphanol Tartrate Tablets (oral) manage pain severe enough to require an opioid pain medicine when other treatments, such as non-opioid pain relievers, have not worked or can't be tolerated.
- They should not be used long term unless the pain stays severe and other options remain inadequate.
How Levorphanol works
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Levorphanol is a full opioid agonist. It mainly attaches to mu-opioid receptors in the brain and spinal cord, which help control pain signals. This changes how you sense pain.
Its pain relief has no ceiling effect, but the dose is limited by side effects such as slowed breathing and sedation. The precise way it relieves pain is unknown.
Levorphanol dosage
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Levorphanol Tartrate Tablets are taken by mouth, usually every 6 to 8 hours as needed for pain. Your prescriber picks the lowest dose that works for the shortest time. The label does not give food or missed-dose instructions, so ask your pharmacist.
- Don't change your dose on your own.
- If you take it on a regular schedule, dose changes need time, about 3 days, to settle before the next adjustment, to avoid too much sedation.
- Older or frail adults may start at a lower dose.
Dosing details from the FDA-approved label
From the Levorphanol prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Use of Levorphanol Tartrate Tablets as the First Opioid Analgesic
- 1 to 2 mg every 6 to 8 hours as needed for pain, at the lowest dose necessary to achieve adequate analgesia
- If necessary, the dose may be increased to up to 3 mg every 6 to 8 hours, after adequate evaluation of the patient's response
- Higher doses may be appropriate in opioid tolerant patients; adjust for severity of pain, age, weight, physical status, underlying diseases and concomitant medications
- Conversion from morphine to Levorphanol Tartrate Tablets
- Total daily dose of levorphanol should begin at approximately 1/15 to 1/12 of the total daily dose of oral morphine the patient previously required, then adjust to the patient's clinical response
- Allow approximately 72 hours after each dose change on fixed-schedule dosing before a subsequent adjustment
- Geriatric patients (aged 65 years or older)
- Usually start at the low end of the dosing range
- The initial dose should be reduced by 50% or more in the infirm elderly patient
- Elderly patients may have increased sensitivity to levorphanol
Read the label’s full dosing text
DOSAGE AND ADMINISTRATION Important Dosage and Administration Instructions Levorphanol Tartrate Tablets should be prescribed only by healthcare professionals who are knowledgeable about the use of opioids and how to mitigate the associated risks. Use the lowest effective dosage for the shortest duration of time consistent with individual patient treatment goals ( see WARNINGS ). Because the risk of overdose increases as opioid doses increase, reserve titration to higher doses of Levorphanol Tartrate Tablets for patients in whom lower doses are insufficiently effective and in whom the expected benefits of using a higher dose opioid clearly outweigh the substantial risks. Many acute pain conditions (e.g., the pain that occurs with a number of surgical procedures or acute musculoskeletal injuries) require no more than a few days of an opioid analgesic. Clinical guidelines on opioid prescribing for some acute pain conditions are available. There is variability in the opioid analgesic dose and duration needed to adequately manage pain due both to the cause of pain and to individual patient factors. Initiate the dosing regimen for each patient individually, taking into account the patient’s underlying cause and severity of pain, prior analgesic treatment and response, and risk factors for addiction, abuse, and misuse ( see WARNINGS ). Respiratory depression can occur at any time during opioid therapy, especially when initiating and following dosage increases with Levorphanol Tartrate Tablets. Consider this risk when selecting an initial dose and when making dose adjustments ( see WARNINGS ). Patient Access to an Opioid Overdose Reversal Agent for the Emergency Treatment of Opioid Overdose Inform patients and caregivers about opioid overdose reversal agents (e.g., naloxone, nalmefene). Discuss the importance of having access to an opioid overdose reversal agent, especially if the patient has risk factors for overdose (e.g., concomitant use of CNS depressants, a history of opioid use disorder, or prior opioid overdose) or if there are household members (including children) or other close contacts at risk for accidental ingestion or opioid overdose.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Levorphanol side effects
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Side effects are typical of opioids and tend to be dose related.
Common side effects
- Nausea
- Vomiting
- Constipation
- Dizziness
- Itching
- Flushing
- Dry mouth
- Trouble urinating
- Dry mouth and sweating
When to get medical help
- Call 911 right away for slow or shallow breathing, extreme sleepiness, trouble waking, or a known or suspected overdose.
- Get help right away for signs of a severe allergic reaction, such as swelling or trouble breathing.
- Call your doctor about confusion, fainting, or a very slow or irregular heartbeat.
- Call your doctor if pain gets worse or more sensitive as the dose goes up.
- Seek help for signs of serotonin syndrome if you also take serotonin-affecting medicines.
- Tell your doctor about thoughts of suicide, or signs of addiction or misuse.
Levorphanol warnings and precautions
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- Addiction, abuse and misuse can occur at normal doses. Risk is higher with a personal or family history of substance abuse or mental illness.
- Slowed breathing can be fatal, especially when starting or raising the dose, and in people with lung disease, older, frail or underweight people.
- Accidental ingestion by a child can be fatal.
- Pregnancy: prolonged use can cause neonatal opioid withdrawal syndrome.
- Other risks include sleep apnea, increased pain sensitivity, adrenal insufficiency, low blood sugar, and low sex hormones with long-term use.
Levorphanol interactions
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Several medicines can make levorphanol riskier.
- Alcohol, benzodiazepines, sleep aids, muscle relaxants, gabapentin, pregabalin, antipsychotics and other opioids: dangerous sedation and slowed breathing.
- Antidepressants, triptans, tramadol, linezolid, MAO inhibitors and methylene blue: serotonin syndrome risk.
- Butorphanol, nalbuphine and pentazocine: may reduce pain relief and cause withdrawal.
- Diuretics: may work less well.
- Anticholinergic drugs: urinary retention and severe constipation.
Interactions listed in the FDA-approved label
From the Levorphanol prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- Benzodiazepines and other CNS depressants (sedative hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids, other opioids, alcohol): Additive pharmacologic effect can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. Reserve concomitant prescribing for patients for whom alternative options are inadequate; limit dosages and durations to the minimum required; inform patients and caregivers; consider recommending or prescribing an opioid overdose reversal agent.
- Serotonergic drugs (SSRIs, SNRIs, TCAs, triptans, 5-HT3 receptor antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAO inhibitors including linezolid and intravenous methylene blue): Concomitant use with opioids has resulted in serotonin syndrome. If concomitant use is warranted, frequently evaluate the patient, particularly during treatment initiation and dose adjustment; discontinue levorphanol tartrate tablets if serotonin syndrome is suspected.
- Mixed agonist/antagonist and partial opioid analgesics (butorphanol, nalbuphine, pentazocine): May reduce the analgesic effect of levorphanol tartrate tablets and precipitate withdrawal symptoms. Advise patient to avoid concomitant use of these drugs.
- Muscle relaxants (e.g., cyclobenzaprine, metaxalone): Levorphanol may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression. If concomitant use is warranted, decrease the dosage of levorphanol tartrate tablets and/or the muscle relaxant as necessary; consider recommending or prescribing an opioid overdose reversal agent.
- Diuretics: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. If concomitant use is warranted, evaluate patients for signs of diminished diuresis and/or effects on blood pressure and increase the dosage of the diuretic as needed.
- Anticholinergic drugs: May increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. If concomitant use is warranted, evaluate patients for signs of urinary retention or reduced gastric motility.
Read the label’s full interactions text
Drug Interactions Benzodiazepines and Other Central Nervous System (CNS) Depressants Due to additive pharmacologic effect, the concomitant use of benzodiazepines and other CNS depressants, such as benzodiazepines, and other sedative hypnotics, anxiolytics, and tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids (gabapentin or pregabalin), and other opioids, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Inform patients and caregivers of this potential interaction, educate them on the signs and symptoms of respiratory depression (including sedation). If concomitant use is warranted, consider recommending or prescribing an opioid overdose reversal agent [see WARNINGS , DOSAGE AND ADMINISTRATION ]. Serotonergic Drugs The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine, metaxalone), and monoamine oxidase (MAO) inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue), has resulted in serotonin syndrome. [see PRECAUTIONS; Information for Patients/Caregivers ]. If concomitant use is warranted, frequently evaluate the patient, particularly during treatment initiation and dose adjustment. Discontinue levorphanol tartrate tablets if serotonin syndrome is suspected.
Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Levorphanol
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- Not for people with significant breathing problems, severe asthma without monitoring, or a stomach or bowel blockage.
- Not for anyone allergic to levorphanol or its ingredients.
- Tell your prescriber about substance use history, depression or other mental illness.
- Tell them if you are pregnant or may become pregnant.
- Older adults are more sensitive, and frail older adults may need a much lower starting dose.
Levorphanol overdose
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Overdose can cause slow or stopped breathing, extreme sleepiness progressing to coma, limp muscles, cold clammy skin, small pupils, and a slow heartbeat or low blood pressure. Call 911 right away. Treatment focuses on supporting breathing and giving naloxone or nalmefene, and monitoring is needed because levorphanol can outlast the reversal medicine.
What Levorphanol does in the body
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Levorphanol relieves pain but also slows breathing by acting on the brain's breathing centers, and it narrows the pupils. It slows the gut, causing constipation, and widens blood vessels, which can cause dizziness on standing. Long-term use may lower sex hormone levels.
How your body processes Levorphanol
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After IV dosing in a small group of cancer patients, levorphanol had a half-life of 11 to 16 hours. Steady levels in the body are expected by about the third day of regular dosing.
How to store Levorphanol
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Store at 20° to 25°C (68° to 77°F). Dispense in a tight, light-resistant container as defined in the USP with a child-resistant closure. Store levorphanol tartrate tablets securely and dispose of properly .
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Levorphanol
100 supplements and herbal products have documented interactions with Levorphanol in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 7
- Moderate · 78
- Minor · 15
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Levorphanol: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Levorphanol — the kind of thing our pharmacy team would talk through with you at the counter.
What is levorphanol for?
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How do I take it?
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What side effects should I expect?
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Can I drink alcohol or take other medicines with it?
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How should I store it?
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Is it safe in pregnancy?
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Is Levorphanol available over the counter?
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Is Levorphanol a controlled substance?
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When was Levorphanol first available?
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Who makes Levorphanol?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Levorphanol on HelloPharmacist
Levorphanol forms and strengths (how it comes)
Levorphanol is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Levorphanol inactive ingredients by manufacturer.
Tablet
How this form is used
- Levorphanol Tartrate Tablets are used for pain severe enough to require an opioid pain medicine when other treatments are inadequate.
- Levorphanol Tartrate Tablets are taken by mouth, usually every 6 to 8 hours as needed for pain.
- Levorphanol Tartrate Tablets should be used at the lowest effective dose for the shortest time needed.
- Levorphanol Tartrate Tablets may need a lower starting dose in frail older adults.
Levorphanol on the U.S. market: products, makers and brands
How Levorphanol appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
7 companies list 10 Levorphanol product records with the FDA, mostly as tablet; the earliest marketing or approval year on record is 1953. Brand names on the directory include Levo-Dromoran, Xyvona; the rest are generics.
Also listed with the FDA, not a patient dose form: Powder (4) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
How widely Levorphanol is used (Medicaid data)
A general measure of how commonly Levorphanol is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Levorphanol is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Levorphanol prescribed? Of the 1,601 medications we measure, Levorphanol ranks #1,279 by Medicaid prescriptions — more than 20% of them.
Utilization by Levorphanol product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
levorphanol tartrate 2 MG Oral Tablet
Summed across the 5 of 10 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197873
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Levorphanol, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 5 of 10 listed Levorphanol NDCs with Medicaid activity.
Compare Levorphanol products
A representative set of FDA-listed product records for Levorphanol — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Tablet | ||||
| 2 mg | Oral | Acertis Pharmaceuticals, Llc | ANDA | View NDC → |
| 2 mg | Oral | Bryant Ranch Prepack × 2 listings | ANDA | View NDC → |
| 2 mg | Oral | Hikma Pharmaceuticals USA Inc. | ANDA | View NDC → |
| 2 mg | Oral | Lannett Company, Inc. | ANDA | View NDC → |
| 3 mg | Oral | Lannett Company, Inc. | ANDA | View NDC → |
| 2 mg | Oral | SpecGx LLC | ANDA | View NDC → |
| 2 mg | Oral | Sun Pharmaceutical Industries, Inc. | ANDA | View NDC → |
| 3 mg | Oral | Sun Pharmaceutical Industries, Inc. | ANDA | View NDC → |
| 2 mg | Oral | Virtus Pharmaceuticals, LLC | ANDA | View NDC → |
Showing 10 of 10 products — FDA National Drug Code Directory. See every product, package size and price: browse all 10 Levorphanol NDCs →
Levorphanol side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Levorphanol — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Levorphanol in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Levorphanol FDA approval history
How Levorphanol went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
Levorphanol recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Levorphanol recalls since July 2021.
✅No Levorphanol recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 6378 1 dose form · 2 strengths
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Dose form (SCDF) Oral Tablet RxCUI 372593In current FDA listings
Look up RxCUI 6378 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Levorphanol supply and shortage status
Whether Levorphanol is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
💵 What Levorphanol costs pharmacies (NADAC benchmark)
The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Sep 30, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.
| Form | Strength | Pharmacy acquisition benchmark | |
|---|---|---|---|
| Tablet · Oral | 2 mg | $10.65 per tablet | NDC details & price history |
Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.
Levorphanol brand names
Levorphanol is sold under 2 brand names in the FDA directory — Levo-Dromoran, Xyvona. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Levorphanol: manufacturers and labelers
7 companies list Levorphanol products with the FDA. By number of product records, the largest are Bryant Ranch Prepack, Lannett Company, Inc., Sun Pharmaceutical Industries, Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Levorphanol drug class (RxNorm)
Levorphanol belongs to the Opioid Agonist class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Levorphanol page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. SpecGx LLC is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →