Nalbuphine

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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

  1. abdominal pain
  2. adrenocortical insufficiency
  3. agitation
  4. amenorrhea
  5. anaphylactic shock
  6. anaphylactoid reactions
  7. anxiety
  8. apnea
  9. blurred vision
  10. bradycardia
  11. bronchospasm
  12. cardiac arrest
  13. confusion
  14. cyanosis
  15. depression
  16. diaphoresis
  17. dizziness
  18. drowsiness
  19. dysarthria
  20. dyspepsia
  21. dysphoria
  22. dyspnea
  23. edema
  24. euphoria
  25. fetal bradycardia
  26. fetal death
  27. fetal distress
  28. fever
  29. flushing
  30. gonadal suppression
  31. hallucinations
  32. headache
  33. hostility
  34. hypertension
  35. hyponatremia
  36. hypotension
  37. hypotonia
  38. impotence (erectile dysfunction)
  39. infertility
  40. injection site reaction
  41. laryngeal edema
  42. libido decrease
  43. nausea
  44. neonatal abstinence syndrome
  45. physiological dependence
  46. pruritus
  47. psychological dependence
  48. psychosis
  49. pulmonary edema
  50. rash
  51. respiratory arrest
  52. respiratory depression
  53. restlessness
  54. seizures
  55. serotonin syndrome
  56. SIADH
  57. sinus tachycardia
  58. tolerance
  59. tremor
  60. urinary urgency
  61. urticaria
  62. vertigo
  63. vomiting
  64. weakness
  65. wheezing
  66. withdrawal
  67. 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

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