nalbuphine (Nubain)

Nalbuphine is a man-made opioid (narcotic) painkiller. Nalbuphine provides pain relief in a similar way as morphine (MS Contin), oxycodone (Oxycontin), and other narcotic analgesics. Narcotic painkillers stimulate the brain to increase the threshold to pain (the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain). Nalbuphine is a mixed opioid agonist and antagonist because it stimulates and blocks pain receptors on nerves. The FDA approved nalbuphine in May 1979.

What brand names are available for nalbuphine?

Nubain

Is nalbuphine available as a generic drug?

Yes

Do I need a prescription for nalbuphine?

Yes

Side effects of Nalbuphine are

• sedation,
• dizziness,
• nausea,
• vomiting,
• dry mouth,
• headache, and
• low heart rate.

Like other narcotics nalbuphine can cause respiratory depression (decreased rate or depth of breathing).

It may produce withdrawal in opioid dependent patients. Nalbuphine is a controlled substance and is habit forming. Mental and physical dependence can occur. Abruptly stopping the drug in patients who have been taking the drug for a long time can precipitate a withdrawal reaction.

Symptoms of withdrawal include

• nausea,
• diarrhea,
• coughing,
• tearing,
• nasal discharge,
• profuse sweating,
• twitching muscles, and
• yawning.

Adults:

• Pain: For a 70 kg patient, inject 10 to 20 mg via subcutaneous, intravenous, or intramuscular route every 3 to 6 hours as needed. Maximum single dose of 20 mg. Maximum daily dose of 160 mg per day.
• Opioid-dependent patients: Administer ¼ of normal dose and observe withdrawal signs.
• Anesthesia supplement: Administer 0.3 to 3 mg/kg intravenously over 10 to 15 minutes, then 0.25 to 0.5 mg/kg as needed.

Nalbuphine should not be used with alvimopan (Entereg) because alvimopan increases nalbuphine levels in the body and increases side effects. Nalbuphine must be discontinued 7 days prior to using alvimopan.

Combining nalbuphine with fentanyl (Duragesic), alfentanil (Alfenta), buprenorphine (Subutex), and other opioid medications increases sedation and may cause withdrawal symptoms in narcotic addicts.

Nalbuphine should not be used with MAO inhibitors like phenelzine (Nardil), selegiline (Zelapar, Emsam, Eldepryl), and isocarboxazid (Marplan) as well as linezolid (Zyvox) antibiotic because they can increase nalbuphine toxicity, causing decreased blood pressure, fever, sleepiness, and in severe cases, death. Nalbuphine administration must be separated by 14 days from MAOI inhibitors and linezolid (Zyvox).

Nalbuphine may enter breast milk in trace amount; therefore, it should be used with caution in mothers who are nursing.

What preparations of nalbuphine are available?

Nalbuphine injections are available in 10 mg/ml and 20 mg/ml strengths in 1 ml ampoule or 10 ml multi-use, flip-top vials.

How should I keep nalbuphine stored?

Store Nalbuphine injections at room temperature between 20 C and 25 C (68 F and 77 F).