nalbuphine (Nubain)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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What is nalbuphine- injection, and how does it work (mechanism of action)?

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- injection?

Nubain

Is nalbuphine- injection available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for nalbuphine- injection?

Yes

What are the side effects of nalbuphine- injection?

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.

Quick GuideChronic Pain: Causes and Solutions

Chronic Pain: Causes and Solutions

What is the dosage for nalbuphine- injection?

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.

Which drugs or supplements interact with nalbuphine- injection?

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).

Is nalbuphine- injection safe to take if I'm pregnant or breastfeeding?

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

What else should I know about nalbuphine- injection?

What preparations of nalbuphine- injection 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- injection stored?

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

REFERENCES:

FDA Prescribing Information.

Medscape. nalbuphine (Rx) - Nubain.

Quick GuideChronic Pain: Causes and Solutions

Chronic Pain: Causes and Solutions

Summary

Nalbuphine hydrochloride (Nubain) is a man-made narcotic painkiller. Nubain is prescribed to treat moderate to severe pain; to be used prior to and during surgery to control pain; and for reducing pain during labor and delivery. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to using this medication.

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Reviewed on 8/15/2014
References
REFERENCES:

FDA Prescribing Information.

Medscape. nalbuphine (Rx) - Nubain.

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