nalbuphine hydrochloride


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nalbuphine hydrochloride

Nubain

Pharmacologic class: Opioid agonist-antagonist

Therapeutic class: Analgesic, adjunct to anesthesia

Pregnancy risk category C

Action

Binds to opiate receptors in CNS, inhibiting ascending pain pathways. This inhibition alters perception of and response to painful stimuli.

Availability

Injection: 10 mg/ml, 20 mg/ml

Indications and dosages

Moderate to severe pain

Adults: 10 mg/70 kg I.V., I.M., or subcutaneously q 3 to 6 hours p.r.n., up to 160 mg/day. Maximum for single dose is 20 mg.

Adjunct to balanced anesthesia

Adults: 0.3 mg to 3 mg/kg I.V. over 10 to 15 minutes, followed by maintenance dose of 0.25 mg to 0.50 mg/kg I.V. in single doses p.r.n.

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

• increased intracranial pressure, head trauma, myocardial infarction, severe heart disease, respiratory depression, renal or hepatic disease, impaired ventilation, hypothyroidism, adrenal insufficiency, prostatic hypertrophy, emotional instability, alcoholism

• history of substance abuse or dependence

• pregnant or breastfeeding patients

• children.

Administration

Make sure emergency resuscitation equipment and naloxone (antidote) are available before starting therapy.

• For I.M. use, inject deep into large muscle mass; rotate injection sites.

• When giving I.V. for pain, infuse undiluted over 2 to 3 minutes into vein or I.V. line with compatible solution (such as dextrose 5% in water, normal saline solution, or lactated Ringer's solution).

Adverse reactions

CNS: dizziness, sedation, headache, vertigo

CV: hypertension, hypotension, tachycardia, bradycardia

EENT: miosis

GI: nausea, vomiting, dry mouth

Respiratory: dyspnea, respiratory depression

Skin: sweating, clammy skin

Other: hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. CNS depressants (including general anesthetics, MAO inhibitors, sedative-hypnotics, tranquilizers, tricyclic antidepressants): additive CNS effects

Drug-diagnostic tests. Amylase, lipase: increased levels

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: additive CNS and respiratory depression

Patient monitoring

• Monitor vital signs. Watch for respiratory depression and heart rate changes.

• Evaluate patient for CNS changes. Institute safety measures as needed to prevent injury.

Watch for hypersensitivity reactions, including anaphylaxis.

Patient teaching

• Instruct patient to change position slowly and carefully to avoid dizziness from sudden blood pressure decrease.

• Tell patient to avoid CNS depressants (including alcohol, sedative-hypnotics, and some herbs) for at least 24 hours after taking nalbuphine.

• Advise patient to consult prescriber before taking herbs.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

nal·bu·phine hydrochloride

(năl-byōō′fēn′)
n.
A synthetic opioid analgesic that has both agonist and antagonist narcotic properties.
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References in periodicals archive ?
Nalbuphine hydrochloride is primarily a kappa agonist/partial mu antagonist analgesic.
A comparison of analgesic effect of different doses of intrathecal nalbuphine hydrochloride with bupivacaine and bupivacaine alone for lower abdominal and orthopedic surgeries.
The drugs used included dextromethophane (40.2%); nalbuphine hydrochloride (28.0%); benzodiazepine (14.0%)i barbiturates (13.8%); anabolic steroids (5.4%); and amphetamines (3.2%).
Female adolescents tended to use illicit drugs, such as barbiturates, dextromethophane, and nalbuphine hydrochloride, while males were more likely to use alcohol, cigarettes, amphetamines, anabolic steroids, philopon, cocaine, and marijuana.
(1996) Three cases of Nalbuphine hydrochloride dependence associated with anabolic steroid use.
(1999) Nalbuphine hydrochloride dependence in anabolic steroid abusers.
TABLE 2 Reported Pain Relief Following Paracervical Block or Intravenous Nalbuphine Hydrochloride
Group II (n=40): Inj Nalbuphine hydrochloride 0.2mg/kg IV 5 min before laryngoscopy and intubation.
(11) In 2011 study by Tiwari and Tomar showed that nalbuphine hydrochloride (400 ng) significantly prolongs the duration of sensory blockade and postoperative analgesia without any side effect or complication when introduced intrathecally along with hyperbaric bupivacaine.