NALBUPHINE HYDROCHLORIDE

NALBUPHINE HYDROCHLORIDE
(nal'byoo-feen)
Nubain
Classifications: analgesic; narcotic (opiate) agonist-antagonist;
Therapeutic: narcotic analgesic
Prototype: Pentazocine
Pregnancy Category: C

Availability

10 mg/mL, 20 mg/mL injection

Action

Synthetic narcotic analgesic with agonist and weak antagonist properties. Analgesic potency is approximately equal to that produced by equivalent doses of morphine. On a weight basis, produces respiratory depression about equal to that of morphine; however, in contrast to morphine, doses greater than 30 mg produce no further respiratory depression. Antagonistic potency is approximately one-fourth that of naloxone.

Therapeutic Effect

Analgesic action that relieves moderate to severe pain with apparently low potential for dependence.

Uses

Symptomatic relief of moderate to severe pain. Also preoperative sedation analgesia and as a supplement to surgical anesthesia.

Contraindications

History of hypersensitivity to nalbuphine, opiate agonists; pregnancy (category C). Prolonged use during pregnancy could result in neonatal withdrawal.

Cautious Use

History of emotional instability or drug abuse; head injury, increased intracranial pressure; cardiac disease; impaired respirations, COPD; GI disorders; impaired kidney or liver function; MI; biliary tract surgery; lactation.

Route & Dosage

Moderate to Severe Pain
Adult: IV/IM/SC 10 mg/70 kg q3–6h prn (max: 160 mg/d)

Surgery Anesthesia Supplement
Adult: IV Induction: 0.3–3 mg/kg, then 0.25–0.5 mg/kg as required

Administration

Intramuscular/Subcutaneous

Inject undiluted.

Intravenous

PREPARE: Direct: Give undiluted.

ADMINISTER: Direct: Give at a rate of 10 mg or fraction thereof over 3–5 min.

INCOMPATIBILITIES Solution/additive: Diazepam, dimenhydrinate, ketorolac, pentobarbital, promethazine, thiethylperazine. Y-site: Allopurinol, amphotericin B cholesteryl, cefepime, docetaxel, methotrexate, nafcillin, piperacillin/tazobactam, sargramostim, sodium bicarbonate.

Store at 15°–30°C (59°–86°F), avoid freezing.

Adverse Effects (≥1%)

CV: Hypertension, hypotension, bradycardia, tachycardia, flushing. GI: Abdominal cramps, bitter taste, nausea, vomiting, dry mouth. CNS: Sedation, dizziness, nervousness, depression, restlessness, crying, euphoria, dysphoria, distortion of body image, unusual dreams, confusion, hallucinations; numbness and tingling sensations, headache, vertigo. Respiratory: Dyspnea, asthma, respiratory depression. Skin: Pruritus, urticaria, burning sensation, sweaty, clammy skin. Special Senses: Miosis, blurred vision, speech difficulty. Urogenital: Urinary urgency.

Interactions

Drug: Alcohol and other cns depressants add to CNS depression.

Pharmacokinetics

Onset: 2–3 min IV; 15 min IM. Peak: 30 min IV. Duration: 3–6 h. Distribution: Crosses placenta. Metabolism: In liver. Elimination: In urine. Half-Life: 5 h.

Nursing Implications

Assessment & Drug Effects

Assess respiratory rate before drug administration. Withhold drug and notify physician if respiratory rate falls below 12.
Watch for allergic response in persons with sulfite sensitivity.
Administer with caution to patients with hepatic or renal impairment.
Monitor ambulatory patients; nalbuphine may produce drowsiness.
Watch for respiratory depression of newborn if drug is used during labor and delivery.
Avoid abrupt termination of nalbuphine following prolonged use, which may result in symptoms similar to narcotic withdrawal: nausea, vomiting, abdominal cramps, lacrimation, nasal congestion, piloerection, fever, restlessness, anxiety.

Patient & Family Education

Do not drive or engage in potentially hazardous activities until response to drug is known.
Avoid alcohol and other CNS depressants.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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