Nalbuphine

Indications
 Parenteral
Moderate to severe pain
Adult: 10-20 mg IM/IV/SC every 3-6 hr as required. Nonopioid-tolerant patients: Max single dose: 20 mg. Max daily dose: 160 mg.
Child: As hydrochloride: Initially, up to 300 mcg/kg then repeat once or twice as needed.
Renal impairment: Reduce dose.
Hepatic impairment: Reduce dose.
Parenteral
Premedication before anaesthesia
Adult: 100-200 mcg/kg. May be given via IM/SC/IV admin.
Renal impairment: Reduce dose.
Hepatic impairment: Reduce dose.
Intravenous
Adjunct in balanced anaesthesia
Adult: Induction: 0.3-1 mg/kg IV over 10-15 minutes; up to 3 mg/kg have been used. Maintenance: 250-500 mcg/kg every 30 minutes.
Renal impairment: Reduce dose.
Hepatic impairment: Reduce dose.
Intravenous
Pain associated with myocardial infarction
Adult: 10-30 mg by slow IV inj; give a 2nd 20-mg dose after 30 min if necessary.

Special Populations: Reduce dose in elderly or debilitated patients and in patients with hepatic or renal impairment.

Incompatibility: Incompatible with allopurinol, amphotericin B cholesteryl sulfate complex, cefepime, docetaxel, ketorolac, methotrexate, nafcillin, piperacillin/tazobactam, sargramostim, sodium bicarbonate for Y-site admin. Do not mix in the same syringe as diazepam, ketorolac, pentobarbital.
Warnings / Precautions
 May impair ability to drive or operate machinery. Emotionally unstable patients or patients with history of opiate abuse; closely monitor these patients during long-term therapy. Impaired respiration due to other drugs, uraemia, bronchial asthma, severe infection, cyanosis, respiratory obstruction. MI patients who exhibit nausea and vomiting and in those about to undergo biliary tract surgery. Head injury, intracranial lesions or pre-existing increased intracranial pressure. Renal or hepatic impairment. Elderly and debilitated patients. Pregnancy and lactation.
Adverse Reactions
 Sedation, dizziness, vertigo, miosis, headache; nausea, vomiting, dry mouth; itching, burning, urticaria. Respiratory depression, dyspnoea, asthma; speech difficulty, urinary urgency, blurred vision, flushing, warmth; clamminess.
Potentially Fatal: Anaphylactic or anaphylactoid and other serious hypersensitivity reactions e.g. shock, respiratory distress, respiratory arrest, bradycardia, cardiac arrest, hypotension, laryngeal oedema.
Overdose Reactions
 Symptoms: CNS depression, respiratory depression, miosis, hypotension, bradycardia. Management: Symptomatic. To reverse opioid effects, naloxone 2 mg IV with repeat admin as needed up to a total dose of 10 mg may be given.
Drug Interactions
 Additive CNS depressant effects may occur with other CNS depressants e.g. alcohol, anaesthetics, anxiolytics, hypnotics, TCAs and antipsychotics.
See Below for More nalbuphine Drug Interactions
Food Interactions
 Additive CNS depression may occur with valerian, St John's wort, kava kava, gotu kola.
Mechanism of Actions
 Nalbuphine is a phenanthrene derivative opioid analgesic with mixed opioid agonist and antagonist activity. It inhibits the ascending pain pathways, altering the perception of and response to pain by binding to opiate receptors in the CNS. It also produces generalised CNS depression.
Onset: IV: 2-3 minutes; SC/IM: 15 minutes.
Duration: 3-6 hr.
Absorption: Peak plasma concentrations after 30 minutes (IM/IV).
Distribution: Crosses the placenta.
Metabolism: Undergoes extensive first-pass metabolism in GI mucosa and liver.
Excretion: Via urine and faeces (as unchanged drug and conjugates). Elimination half-life: 5 hr.
Storage Conditions
 Intravenous: Store at 15-30°C (59-86°F). Protect from light. Parenteral: Store at 15-30°C (59-86°F). Protect from light.
ATC Classification
 N02AF02 - nalbuphine ; Belongs to the class of morphinan derivative opioids. Used to relieve pain.
Storage
 Intravenous: Store at 15-30°C (59-86°F). Protect from light. Parenteral: Store at 15-30°C (59-86°F). Protect from light.
Available As
  • Nalbuphine 10 mg
  • Nalbuphine 20 mg

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