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

Availability

10 mg/mL, 20 mg/mL injection

Actions

Synthetic narcotic analgesic with agonist and weak antagonist properties. Analgesic potency is about 3 or 4 times greater than that of pentazocine and 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 >30 mg produce no further respiratory depression. Antagonistic potency is approximately one fourth that of naloxone and about 10 times greater than that of pentazocine.

Therapeutic Effects

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 drug. Safety during pregnancy (category C) or lactation is not established. Prolonged use during pregnancy could result in neonatal withdrawal.

Cautious Use

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

Route & Dosage

Moderate to Severe Pain
Adult: IV/IM/SC 10–20 mg q3–6h prn (max: 160 mg/d)
Child: IV/IM/SC 0.1–0.15 mg/kg q3–6h prn

Administration

Intramuscular/Subcutaneous

Inject undiluted.

Intravenous

Note: Verify correct rate of IV injection in infants, children with physician.

PREPARE: Direct: Give undiluted.

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

INCOMPATIBILITIES Solution/additive: Diazepam, pentobarbital, promethazine, thiethylperazine. Y-site: Nafcillin.

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: Metabolized in liver. Elimination: Eliminated 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.
Do not breast feed while taking this drug without consulting physician.

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