Dosing and uses of Nubain (nalbuphine)
Adult dosage forms and strengths
injectable solution
- 10mg/mL
- 20mg/mL
Pain
Non-opioid-tolerant patients: 10-20 mg/70kg IV/IM/SC q3-6hr PRN; individual dose not to exceed 20 mg
Opioid-dependent patients: Administer ¼ dose, and observe for withdrawal signs
Not to exceed 160 mg/day
Anesthesia Supplement
0.3-3 mg/kg IV over 10-15 minutes, then 0.25-0.5 mg/kg PRn
Opioid-Induced Pruritus (Off-label)
Prevention and treatment
Dosing Modifications
Renal impairment: Caution; dose reduction may be necessary; monitor
Hepatic impairment: Caution; dose reduction may be necessary; monitor
Pediatric dosage forms and strengths
injectable solution
- 10mg/mL
- 20mg/mL
Pain
<1 year: Safety and efficacy not established
>1 year: 0.1-0.2 mg/kg IV/IM/SC q3-4hr PRN; individual dose not to exceed 20 mg; not to exceed 160 mg/day
Nubain (nalbuphine) adverse (side) effects
>10%
Sedation (36%)
1-10%
Clamminess (9%)
Nausea and vomiting (6%)
Dizziness (5%)
Xerostomia (4%)
Headache (3%)
<1%
Asthma
Bradycardia
Burning
Dyspnea
Hypertension
Hypotension
Itching
Miosis
Pulmonary edema
Respiratory depression
Tachycardia
Urticaria
Vertigo
Warnings
Contraindications
Absolute: Diarrhea associated with toxins, pseudomembranous colitis, respiratory depression (<12 beats/min)
Acute asthma, bradycardia, inflammatory bowel disease, respiratory impairment
Cautions
Respiratory impairment; nalbuphine poses less risk of respiratory sedation than pure opioid agonists
May produce withdrawal in opioid-dependent patients
Pregnant patients (risk of serious fetal/neonatal adverse events associated with use during labor and delivery, including respiratory depression at birth, fetal bradycardia, apnea, cyanosis)
Head trauma, increased ICp
Myocardial infarction
Hepatic or renal impairment
Patients undergoing biliary tract surgery
Pregnancy and lactation
Pregnancy category: B; D if used for prolonged periods or near term
Lactation: Insignificant amount distributed in milk; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Nubain (nalbuphine)
Mechanism of action
Narcotic agonist-analgesic of kappa opiate receptors and partial antagonist of mu opiate receptors; inhibits ascending pain pathways, thus altering response to pain; produces analgesia, respiratory depression, and sedation
Absorption
Onset: IM, 15 min; IV, 2-3 min
Duration: 3-6 hr
Peak plasma time: IM, 30 min; IV, 1-3 min
Distribution
Protein bound: Not significant
Metabolism
Metabolized in liver
Elimination
Half-life: 5 hr
Excretion: Urine, feces
Administration
IV Incompatibilities
Syringe: Diazepam, ketorolac, pentobarbitaL
Y-site: Allopurinol, amphotericin B cholesteryl sulfate, cefepime, docetaxel, methotrexate, nafcillin, piperacillin-tazobactam, sargramostim, sodium bicarbonate
IV Preparation
Adjusted pH: 3.5-3.7
May be given undiluted
IV Administration
Administer each 10 mg by IV push over 3-5 minutes
IV Storage
Store vial at room temperature
