Nalbuphine Brand Name– Nubain
What is Nalbuphine
Nalbuphine is a synthetic opiate agonist/antagonist that is chemically related to both naloxone, a narcotic antagonist, and oxymorphone, a potent opiate agonist.
Nalbuphine has analgesic activity essentially equivalent to morphine on a mg-to-mg basis.
The opioid antagonist activity of nalbuphine is approximately 10-times pentazocine. Nalbuphine is used to treat moderate to severe pain associated with acute and chronic medical disorders such as cancer, renal or biliary colic, migraine or vascular headaches, and surgical pain.
Another clinical use is obstetrical analgesia during labor and delivery. However, nalbuphine does not offer significant advantages over pure opiate-agonists in the treatment of acute pain or cancer pain.
Although nalbuphine does produce respiratory depression to the same degree as equianalgesic doses of morphine, nalbuphine exhibits a ceiling effect such that doses > 30 mg do not produce further respiratory depression, in the absence of other CNS depressants.
Nalbuphine was approved by the FDA in 1979.
It is not a controlled substance.
Indications
- general anesthesia induction
- general anesthesia maintenance
- moderate pain
- preanesthesia
- severe pain
For the relief of moderate pain to severe pain and for pain associated with obstetric labor and delivery
Side Effects
- abdominal pain
- adrenocortical insufficiency
- agitation
- amenorrhea
- anaphylactic shock
- anaphylactoid reactions
- anxiety
- apnea
- blurred vision
- bradycardia
- bronchospasm
- cardiac arrest
- confusion
- cyanosis
- depression
- diaphoresis
- dizziness
- drowsiness
- dysarthria
- dyspepsia
- dysphoria
- dyspnea
- edema
- euphoria
- fetal bradycardia
- fetal death
- fetal distress
- fever
- flushing
- gonadal suppression
- hallucinations
- headache
- hostility
- hypertension
- hyponatremia
- hypotension
- hypotonia
- impotence (erectile dysfunction)
- infertility
- injection site reaction
- laryngeal edema
- libido decrease
- nausea
- neonatal abstinence syndrome
- physiological dependence
- pruritus
- psychological dependence
- psychosis
- pulmonary edema
- rash
- respiratory arrest
- respiratory depression
- restlessness
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- tolerance
- tremor
- urinary urgency
- urticaria
- vertigo
- vomiting
- weakness
- wheezing
- withdrawal
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- abrupt discontinuation
- acute myocardial infarction
- adrenal insufficiency
- alcoholism
- angina
- asthma
- biliary tract disease
- breast-feeding
- cardiac disease
- children
- chronic obstructive pulmonary disease (COPD)
- coadministration with other CNS depressants
- constipation
- diarrhea
- driving or operating machinery
- geriatric
- GI disease
- GI obstruction
- head trauma
- heart failure
- hepatic disease
- hypothyroidism
- increased intracranial pressure
- infection
- inflammatory bowel disease
- intracranial mass
- labor
- myxedema
- neonatal opioid withdrawal syndrome
- obstetric delivery
- opiate agonist hypersensitivity
- paraben hypersensitivity
- pregnancy
- pulmonary disease
- renal failure
- renal impairment
- respiratory depression
- respiratory insufficiency
- substance abuse
- ulcerative colitis
- uremia
- ventricular dysfunction
Interactions
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Codeine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Tramadol
- Alfentanil
- Almotriptan
- Alprazolam
- Amifampridine
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amoxapine
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Anticholinergics
- Aripiprazole
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- atypical antipsychotic
- Azelastine
- Azelastine; Fluticasone
- Baclofen
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Benztropine
- Brexpiprazole
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion; Naltrexone
- Buspirone
- Butorphanol
- Cannabidiol
- Capsaicin; Metaxalone
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chloral Hydrate
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorzoxazone
- Clobazam
- Clomipramine
- Clonazepam
- Clorazepate
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Cyclobenzaprine
- Dantrolene
- Desipramine
- Deutetrabenazine
- Dextroamphetamine
- Diazepam
- Dicyclomine
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Dolasetron
- Doxepin
- Dronabinol
- Droperidol
- Eletriptan
- Enflurane
- Entacapone
- Esketamine
- Estazolam
- Eszopiclone
- Ethanol
- Etomidate
- Ezogabine
- Fenfluramine
- Fentanyl
- Flavoxate
- Flibanserin
- Fluoxetine; Olanzapine
- Flurazepam
- Fospropofol
- Frovatriptan
- Gabapentin
- General anesthetics
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Granisetron
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Haloperidol
- Halothane
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Iloperidone
- Imipramine
- Indacaterol; Glycopyrrolate
- Isoflurane
- Ketamine
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levomethadyl
- Levomilnacipran
- Levorphanol
- Linezolid
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lorazepam
- Lorcaserin
- Lumateperone
- Lurasidone
- Magnesium Salts
- Maprotiline
- Mepenzolate
- Meperidine
- Meperidine; Promethazine
- Meprobamate
- Metaxalone
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methocarbamol
- Methscopolamine
- Methylene Blue
- Methylphenidate
- Midazolam
- Milnacipran
- Minocycline
- Mirtazapine
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nalmefene
- Naloxone
- Naltrexone
- Naproxen; Sumatriptan
- Naratriptan
- Nefazodone
- Nortriptyline
- Olanzapine
- Ondansetron
- Orphenadrine
- Oxazepam
- Oxybutynin
- Oxycodone
- Oxymorphone
- Ozanimod
- Paliperidone
- Palonosetron
- Paroxetine
- Pentazocine
- Pentazocine; Naloxone
- Perphenazine; Amitriptyline
- Phenothiazines
- Pimozide
- Pramipexole
- Pregabalin
- Propantheline
- Propofol
- Propoxyphene
- Protriptyline
- Quazepam
- Quetiapine
- Rasagiline
- Remifentanil
- Risperidone
- Rizatriptan
- Rotigotine
- Safinamide
- Scopolamine
- Sedating H1-blockers
- Selegiline
- Serotonin-Receptor Agonists
- Serotonin-Receptor Antagonists
- Sertraline
- Sevoflurane
- Sibutramine
- Solifenacin
- St. John’s Wort, Hypericum perforatum
- Sufentanil
- Sumatriptan
- Suvorexant
- Tapentadol
- Tedizolid
- Temazepam
- Tetrabenazine
- Thalidomide
- Thiothixene
- Tizanidine
- Tolcapone
- Tolterodine
- Tramadol
- Trazodone
- Triazolam
- Tricyclic antidepressants
- Trihexyphenidyl
- Trimethobenzamide
- Trimipramine
- Trospium
- Venlafaxine
- Vigabatrin
- Vilazodone
- Vortioxetine
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolmitriptan
- Zolpidem
