Trade Names:Nubain- Injection 10 mg/mL- Injection 20 mg/mLNubain (Canada)
An opiate analgesic with both narcotic agonist and antagonist actions. Analgesic potency is about equal to that of morphine, and antagonist potency is about 1/ 25 that of naloxone. May cause sphincter of Oddi spasm. Does not increase pulmonary artery pressure, systemic vascular resistance, or myocardial work load.
When nalbuphine is taken orally, it is not as effective for pain relief as when given IM, mainly because of first-pass metabolism in GI and liver. T max is 30 min (IM).
Nalbuphine is not bound to plasma proteins. Nalbuphine crosses the placenta.
Metabolized in the liver.
Approximately 7% eliminated in urine unchanged and in feces. Plasma t 1/ 2 is 5 h and t 1/ 2 is 2.4 h.
Onset of IV nalbuphine is 2 to 3 min. Onset of subcutaneous and IM nalbuphine is less than 15 min.
Duration of analgesic activity is 3 to 6 h.
Management of moderate to severe pain; preoperative and postoperative analgesia; supplement to balanced anesthesia; obstetrical analgesia during labor and delivery.
Prevention and treatment of intrathecal morphine-induced pruritus after cesarean delivery.
Subcutaneous / IM / IV 10 mg per 70 kg q 3 to 6 h as needed. Individualize dosage. In nontolerant patients, do not exceed 20 mg/dose or 160 mg/day.
Store ampules and vials at controlled room temperature (59° to 86°F). Protect from excessive light. Store ampules and vials in carton until contents have been used.
Increased respiratory and CNS depression.
May interfere with enzymatic methods for detection of opioids, depending on the specificity of test.
Bradycardia, hypertension, hypotension, tachycardia (1% or less).
Sedation (36%); dizziness, vertigo (5%); headache (3%); agitation, confusion, crying, depression, dysphoria, euphoria, faintness, floating feeling, hallucinations, heaviness feeling, hostility, nervousness, numbness, restlessness, seizures, tingling, unreality, unusual dreams (1% or less).
Flushing (1% or less).
Blurred vision (1% or less).
Nausea, vomiting (6%); dry mouth (4%); bitter taste, cramps, dyspepsia (1% or less).
Urinary urgency (1% or less).
Anaphylactic or anaphylactoid and other hypersensitivity reactions (including shock, respiratory distress, respiratory arrest, bradycardia, cardiac arrest, hypotension, or laryngeal edema), stridor, bronchospasm, wheezing, edema, rash, pruritus, nausea, vomiting, diaphoresis, weakness, shakiness (1% or less).
Injection site reactions including burning, hot sensations, pain, redness, swelling (postmarketing).
Pulmonary edema (postmarketing).
Sweaty/clammy feeling (9%); speech difficulty, warmth (1% or less).
Category B .
Excreted in breast milk.
Safety and efficacy not established.
Duration of action may be prolonged in patients with renal function impairment; may need to reduce dose.
Duration of action may be prolonged in patients with hepatic function impairment; may need to reduce dose.
Use drug with caution in patients with impaired respiration, head injury, increased intracranial pressure, or MI with nausea or vomiting, and in patients about to undergo biliary tract surgery.
Contains sodium metabisulfite, which may cause allergic-type reactions including anaphylactic symptoms and life-threatening asthma.
Low abuse potential; however, withdrawal symptoms can occur after long-term use. Use drug with caution in patients who are emotionally unstable or have history of narcotic abuse.
Nalbuphine can precipitate withdrawal; small doses of morphine can be given to relieve discomfort. If patient has received morphine, meperidine, codeine, or other opiate of similar duration, give 25% of normal nalbuphine dose first. Observe for signs of withdrawal and increase nalbuphine dose slowly.
Respiratory depression, hypoxemia, sedation.
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