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nalbuphine (Rx)Brand and Other Names:Nubain

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 20mg/mL
more...

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

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 20mg/mL
more...

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 

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Interactions

Interaction Checker

nalbuphine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
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            Adverse 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

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            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

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            Pregnancy & 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.

            more...
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            Pharmacology

            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

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            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

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Select a class to view formulary status for similar drugs

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