Nalbuphine


Full Prescribing Info
Dosage/Direction for Use

Parenteral
Moderate to severe pain
Adult: IM/IV/SC: 10-20 mg 3-6 hrly as required. Non-opioid-tolerant patients: Max single dose: 20 mg. Max daily dose: 160 mg.
Renal impairment: Reduce dose.
Hepatic impairment:
Reduce dose.
Incompatibility: Y-site: Allopurinol, amphotericin B cholesteryl sulfate complex, cefepime, docetaxel, methotrexate, nafcillin, piperacillin/tazobactam, pemetrexed, sargramostim, Na bicarbonate. Syringe: Diazepam, dimenhydrinate, ketorolac, pentobarbital.

Intravenous
Adjunct in balanced anaesthesia

Adult: Induction: 0.3-3 mg/kg over 10-15 min. Maintenance: 0.25-0.5 mg/kg as single admin if required.
Renal impairment: Reduce dose.
Hepatic impairment:
Reduce dose.
Incompatibility: Y-site: Allopurinol, amphotericin B cholesteryl sulfate complex, cefepime, docetaxel, methotrexate, nafcillin, piperacillin/tazobactam, pemetrexed, sargramostim, Na bicarbonate. Syringe: Diazepam, dimenhydrinate, ketorolac, pentobarbital.
Special Precautions
Emotionally unstable patients. Patient w/ MI who exhibit nausea and vomiting, history of opiate abuse, impaired respiration due to other drugs, uraemia, bronchial asthma, severe infection, cyanosis or resp obstruction; about to undergo biliary tract surgery; head injury, intracranial lesions or pre-existing increased intracranial pressure. Renal or hepatic impairment. Pregnancy and lactation. Patient Counselling This drug may cause drowsiness and dizziness, if affected, do not drive or operate machinery. Monitoring Parameters Monitor relief of pain, resp and mental status, BP.
Adverse Reactions
Sedation, dizziness, vertigo, miosis, headache; depression, restlessness, nervousness, crying, drunkenness, euphoria, floating, hostility, confusion, unusual dreams, faintness, feeling of heaviness, tingling, numbness; nausea, vomiting, dry mouth; bradycardia, tachycardia, HTN, hypotension, pulmonary oedema; itching, burning, urticaria; resp depression, dyspnoea, asthma; speech difficulty, urinary urgency, blurred vision, flushing, warmth, sweatiness, clamminess.
Potentially Fatal: Anaphylactic or anaphylactoid and other serious hypersensitivity reactions (e.g. shock, resp distress or arrest, bradycardia, cardiac arrest, hypotension, laryngeal oedema).
ROUTE(S) : Parenteral / SC: B Prolonged use may cause neonatal opioid withdrawal syndrome (NOWS)
ROUTE(S) : IM / IV: B Prolonged use may cause neonatal opioid withdrawal syndrome (NOWS)
Overdosage
Symptoms: Resp depression, CV effects, other CNS effects, sleepiness, mild dysphoria. Management: Supportive treatment. Immediate IV admin of an opiate antagonist (e.g. naloxone or nalmefene) as specific antidote. Admin of oxygen, IV fluids and vasopressors as necessary.
Drug Interactions
Additive CNS depressant effects w/ other CNS depressants (e.g. general anaesth, phenothiazines, other tranquilisers, sedatives, hypnotics).
Food Interaction
Additive CNS depression w/ alcohol.
Action
Nalbuphine is a phenanthrene derivative w/ mixed opioid agonist and antagonist activity (agonist at kappa opiate receptor; partial antagonist at mc receptor). It inhibits the ascending pain pathways, alters the perception of and response to pain by binding to opiate receptors in the CNS. It also produces generalised CNS depression.
Onset: 2-3 min (IV); <15 min (IM/SC).
Duration: 3-6 hr.
Absorption: Time to peak plasma concentration: 30 min (IM).
Distribution: Crosses the placenta and distributed in breast milk (small amounts). Plasma protein binding: Approx 50%.
Metabolism: Undergoes extensive first-pass metabolism in GI mucosa and liver.
Excretion: Via urine and faeces (as unchanged drug and conjugates). Elimination half-life: 5 hr.
Storage
Intravenous: Store between 15-30°C. Protect from light. Parenteral: Store between 15-30°C. Protect from light.
CIMS Class
ATC Classification
N02AF02 - nalbuphine ; Belongs to the class of morphinan derivative opioids. Used to relieve pain.
Disclaimer: This information is independently developed by CIMS based on nalbuphine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 CIMS. All rights reserved. Powered by CIMSAsia.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in