Dosing & Uses
Dosage Forms & 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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- alvimopan
alvimopan, nalbuphine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.
Serious - Use Alternative (55)
- alfentanil
nalbuphine, alfentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- belladonna and opium
nalbuphine, belladonna and opium. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
nalbuphine decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients.
benzhydrocodone/acetaminophen and nalbuphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine
buprenorphine, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- buprenorphine buccal
buprenorphine buccal, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- buprenorphine subdermal implant
buprenorphine subdermal implant and nalbuphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
buprenorphine transdermal and nalbuphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and nalbuphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- butorphanol
butorphanol, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- calcium/magnesium/potassium/sodium oxybates
nalbuphine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- cimetidine
cimetidine increases effects of nalbuphine by decreasing metabolism. Avoid or Use Alternate Drug.
- clonidine
clonidine, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.
- codeine
nalbuphine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- desvenlafaxine
desvenlafaxine and nalbuphine both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome
- dextromoramide
nalbuphine, dextromoramide. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diamorphine
nalbuphine, diamorphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diazepam intranasal
diazepam intranasal, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- difenoxin hcl
nalbuphine, difenoxin hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- diphenoxylate hcl
nalbuphine, diphenoxylate hcl. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- dipipanone
nalbuphine, dipipanone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- eluxadoline
nalbuphine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .
- fentanyl
fentanyl, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
nalbuphine decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl intranasal
fentanyl intranasal, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
nalbuphine decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl transdermal
fentanyl transdermal, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
nalbuphine decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - fentanyl transmucosal
fentanyl transmucosal, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
nalbuphine decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms. - hydrocodone
nalbuphine decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.
hydrocodone, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - hydromorphone
nalbuphine, hydromorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- isocarboxazid
isocarboxazid increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- levorphanol
nalbuphine, levorphanol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- linezolid
linezolid increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- meperidine
nalbuphine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- methadone
nalbuphine, methadone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- metoclopramide intranasal
nalbuphine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- morphine
nalbuphine, morphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oliceridine
nalbuphine, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.
- olopatadine intranasal
nalbuphine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- opium tincture
nalbuphine, opium tincture. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxycodone
nalbuphine, oxycodone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- oxymorphone
nalbuphine, oxymorphone. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- ozanimod
ozanimod and nalbuphine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- papaveretum
nalbuphine, papaveretum. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- pentazocine
nalbuphine, pentazocine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- phenelzine
phenelzine increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- procarbazine
procarbazine increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .
- rasagiline
rasagiline increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. May cause additive CNS depression, drowsiness, dizziness or hypotension, so use with MAOIs should be cautious; lower initial dosages of the analgesic are recommended followed by careful titration. Avoid combination within 14 days of MAOI use.
- selegiline transdermal
selegiline transdermal increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.
- selinexor
selinexor, nalbuphine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sodium oxybate
nalbuphine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sufentanil
nalbuphine, sufentanil. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- sufentanil SL
nalbuphine decreases effects of sufentanil SL by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of opioid mixed agonist/antagonist or partial agonist may reduce sufentail SL analgesic effect and/or precipitate withdrawal symptoms.
sufentanil SL, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation. - tapentadol
nalbuphine, tapentadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.
- tramadol
tramadol, nalbuphine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.
nalbuphine, tramadol. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx. - tranylcypromine
tranylcypromine increases toxicity of nalbuphine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.
- valerian
valerian and nalbuphine both increase sedation. Avoid or Use Alternate Drug.
- venlafaxine
venlafaxine and nalbuphine both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndrome
Monitor Closely (194)
- acrivastine
acrivastine and nalbuphine both increase sedation. Use Caution/Monitor.
- albuterol
nalbuphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
alfentanil and nalbuphine both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and nalbuphine both increase sedation. Use Caution/Monitor.
- amisulpride
amisulpride and nalbuphine both increase sedation. Use Caution/Monitor.
- amitriptyline
nalbuphine and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and nalbuphine both increase sedation. Use Caution/Monitor.
- amoxapine
nalbuphine and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
nalbuphine and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
nalbuphine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
nalbuphine and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
nalbuphine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and nalbuphine both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and nalbuphine both increase sedation. Use Caution/Monitor.
- avapritinib
avapritinib and nalbuphine both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and nalbuphine both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and nalbuphine both increase sedation. Use Caution/Monitor.
- belladonna and opium
nalbuphine and belladonna and opium both increase sedation. Use Caution/Monitor.
- benperidol
nalbuphine and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
nalbuphine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexanolone
brexanolone, nalbuphine. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and nalbuphine both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and nalbuphine both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and nalbuphine both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and nalbuphine both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and nalbuphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and nalbuphine both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
nalbuphine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and nalbuphine both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and nalbuphine both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and nalbuphine both increase sedation. Use Caution/Monitor.
- caffeine
nalbuphine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and nalbuphine both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and nalbuphine both increase sedation. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and nalbuphine both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and nalbuphine both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and nalbuphine both increase sedation. Use Caution/Monitor.
- chlorpromazine
nalbuphine and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and nalbuphine both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and nalbuphine both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and nalbuphine both increase sedation. Use Caution/Monitor.
- clomipramine
nalbuphine and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and nalbuphine both increase sedation. Use Caution/Monitor.
- clozapine
nalbuphine and clozapine both increase sedation. Use Caution/Monitor.
- codeine
codeine and nalbuphine both increase sedation. Use Caution/Monitor.
- cyclizine
cyclizine and nalbuphine both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and nalbuphine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and nalbuphine both increase sedation. Use Caution/Monitor.
- dantrolene
dantrolene and nalbuphine both increase sedation. Use Caution/Monitor.
- daridorexant
nalbuphine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desflurane
desflurane and nalbuphine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.
- desipramine
nalbuphine and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
nalbuphine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and nalbuphine both increase sedation. Use Caution/Monitor.
- dexfenfluramine
nalbuphine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and nalbuphine both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
nalbuphine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
nalbuphine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
dextromoramide and nalbuphine both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and nalbuphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- diethylpropion
nalbuphine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and nalbuphine both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and nalbuphine both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and nalbuphine both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and nalbuphine both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl and nalbuphine both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and nalbuphine both increase sedation. Use Caution/Monitor.
- dobutamine
nalbuphine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
nalbuphine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
nalbuphine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
nalbuphine and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
nalbuphine and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and nalbuphine both increase sedation. Use Caution/Monitor.
- droperidol
nalbuphine and droperidol both increase sedation. Use Caution/Monitor.
- ephedrine
nalbuphine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
nalbuphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
nalbuphine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, nalbuphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and nalbuphine both increase sedation. Use Caution/Monitor.
- ethanol
nalbuphine and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and nalbuphine both increase sedation. Use Caution/Monitor.
- fenfluramine
nalbuphine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
nalbuphine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
nalbuphine and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- formoterol
nalbuphine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gabapentin
gabapentin, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- gabapentin enacarbil
gabapentin enacarbil, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- ganaxolone
nalbuphine and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
nalbuphine and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
hydromorphone and nalbuphine both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and nalbuphine both increase sedation. Use Caution/Monitor.
- iloperidone
nalbuphine and iloperidone both increase sedation. Use Caution/Monitor.
- imipramine
nalbuphine and imipramine both increase sedation. Use Caution/Monitor.
- isoproterenol
nalbuphine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and nalbuphine both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
nalbuphine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, nalbuphine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, nalbuphine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- levalbuterol
nalbuphine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
levorphanol and nalbuphine both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
nalbuphine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
nalbuphine and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
nalbuphine and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and nalbuphine both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- lormetazepam
lormetazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- loxapine
nalbuphine and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
nalbuphine and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, nalbuphine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
nalbuphine and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
nalbuphine and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
nalbuphine and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and nalbuphine both increase sedation. Use Caution/Monitor.
- meprobamate
nalbuphine and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
nalbuphine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and nalbuphine both increase sedation. Use Caution/Monitor.
- methadone
methadone and nalbuphine both increase sedation. Use Caution/Monitor.
- methamphetamine
nalbuphine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and nalbuphine both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
nalbuphine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and nalbuphine both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
nalbuphine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
nalbuphine and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
nalbuphine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and nalbuphine both increase sedation. Use Caution/Monitor.
- motherwort
nalbuphine and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
nalbuphine and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
nalbuphine and nabilone both increase sedation. Use Caution/Monitor.
- norepinephrine
nalbuphine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
nalbuphine and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
nalbuphine and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, nalbuphine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- opium tincture
nalbuphine and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and nalbuphine both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- oxycodone
nalbuphine and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
nalbuphine and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
nalbuphine and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
nalbuphine and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
nalbuphine and papaverine both increase sedation. Use Caution/Monitor.
- pegvisomant
nalbuphine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.
- pentazocine
nalbuphine and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and nalbuphine both increase sedation. Use Caution/Monitor.
- perphenazine
nalbuphine and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
nalbuphine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and nalbuphine both increase sedation. Use Caution/Monitor.
- phentermine
nalbuphine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
nalbuphine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
nalbuphine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
nalbuphine and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
nalbuphine and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
nalbuphine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, nalbuphine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
- primidone
primidone and nalbuphine both increase sedation. Use Caution/Monitor.
- prochlorperazine
nalbuphine and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and nalbuphine both increase sedation. Use Caution/Monitor.
- propofol
propofol and nalbuphine both increase sedation. Use Caution/Monitor.
- propylhexedrine
nalbuphine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
nalbuphine and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- quetiapine
nalbuphine and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
nalbuphine and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, nalbuphine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- risperidone
nalbuphine and risperidone both increase sedation. Use Caution/Monitor.
- salmeterol
nalbuphine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
nalbuphine and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and nalbuphine both increase sedation. Use Caution/Monitor.
- sevoflurane
sevoflurane and nalbuphine both increase sedation. Use Caution/Monitor.
- shepherd's purse
nalbuphine and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, nalbuphine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
- sufentanil
nalbuphine and sufentanil both increase sedation. Use Caution/Monitor.
- suvorexant
suvorexant and nalbuphine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary
- tapentadol
nalbuphine and tapentadol both increase sedation. Use Caution/Monitor.
- temazepam
temazepam and nalbuphine both increase sedation. Use Caution/Monitor.
- terbutaline
nalbuphine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
nalbuphine and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
nalbuphine and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
nalbuphine and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
nalbuphine and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
nalbuphine and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and nalbuphine both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and nalbuphine both increase sedation. Use Caution/Monitor.
- trifluoperazine
nalbuphine and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
nalbuphine and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and nalbuphine both increase sedation. Use Caution/Monitor.
- xylometazoline
nalbuphine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
nalbuphine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
nalbuphine and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
nalbuphine and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
nalbuphine and zotepine both increase sedation. Use Caution/Monitor.
Minor (6)
- brimonidine
brimonidine increases effects of nalbuphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- dextroamphetamine
dextroamphetamine increases effects of nalbuphine by unspecified interaction mechanism. Minor/Significance Unknown.
- eucalyptus
nalbuphine and eucalyptus both increase sedation. Minor/Significance Unknown.
- lidocaine
lidocaine increases toxicity of nalbuphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- sage
nalbuphine and sage both increase sedation. Minor/Significance Unknown.
- ziconotide
ziconotide, nalbuphine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.
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
Warnings
Black Box Warnings
Coadministration with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death
Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation
Instruct patients not to consume alcoholic beverages or use alcohol-containing drug products while taking morphine due to risk of additive sedation and respiratory depression
Contraindications
Significant respiratory depression
Diarrhea associated with toxins, gastrointestinal obstruction, including pseudomembranous colitis
Acute or severe bronchial asthma, bradycardia, inflammatory bowel disease
Cautions
Cases of serotonin syndrome, a potentially life-threatening condition, reported with concomitant use of serotonergic drugs; this may occur within the recommended dosage range; the onset of symptoms generally occur within several hours to a few days of concomitant use, but may occur later than that; discontinue therapy immediately if serotonin syndrome is suspected
Therapy may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients; there is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics); monitor patients for signs of hypotension after initiating or titrating dosage; in patients with circulatory shock, therapy may cause vasodilation that can further reduce cardiac output and blood pressure; avoid therapy in patients with circulatory shock
In patients who may be susceptible to intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), therapy may reduce respiratory drive, and resultant CO2 retention can further increase intracranial pressure; monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy; opioids may obscure clinical course in a patient with a head injury; avoid the use in patients with impaired consciousness or coma
Contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus; may cause spasm of sphincter of Oddi; opioids may cause increases in serum amylase; monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms
Therapy may increase frequency of seizures in patients with seizure disorders and in other clinical settings associated with seizures; monitor patients for worsened seizure control during therapy
Avoid use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic; mixed agonist/antagonist and partial agonist analgesics may reduce analgesic effect and/or precipitate withdrawal symptoms; when discontinuing therapy in physically-dependent patient, gradually taper dosage; do not abruptly discontinue therapy in these patients
Warn patients not to drive or operate dangerous machinery unless they are tolerant to effects of drug and know how they will react to medication
While serious, life-threatening, or fatal respiratory depression can occur at any time during therapy, risk is greatest during initiation of therapy or following dosage increase; monitor patients closely for respiratory depression, especially within first 24 to 72 hr of initiating therapy with and following dosage increases; accidental ingestion of even one dose, especially by children, can result in respiratory depression and death due to overdose of opioid
Opioids can cause sleep-related breathing disorders including central sleep apnea (CSA) and sleep-related hypoxemia; opioid use increases risk of CSA in a dose-dependent fashion; in patients who present with CSA, consider decreasing opioid dosage using best practices for opioid taper
Deaths have occurred in nursing infants exposed to high levels of opioid in breast milk because mothers were ultra-rapid metabolizers of opioid
Profound sedation, respiratory depression, coma, and death may result from concomitant administration with benzodiazepines or other CNS depressants (e.g., non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol); because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
Use in patients with acute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipment is contraindicated; patients with significant chronic obstructive pulmonary disease or cor pulmonale, and with substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression are at increased risk of decreased respiratory drive including apnea, even at recommended dosages
Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients; monitor closely
Monoamine oxidase inhibitors (MAOIs) may potentiate effects of opioid, opioid’s active metabolite, including respiratory depression, coma, and confusion; therapy should not be administered within 14 days of initiating or stopping MAOIs
Cases of adrenal insufficiency reported with opioid use, more often following greater than one month of use; symptoms may include nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure; if adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids; wean patient off of opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers; other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency
Use caution when selecting dosage for an elderly patient, usually starting at low end of dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy; because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and may be useful to monitor renal function
Respiratory impairment; nalbuphine poses less risk of respiratory sedation than pure opioid agonists
Myocardial infarction
Cautions in hepatic impairment
Patients undergoing biliary tract surgery
Pregnancy & Lactation
Pregnancy
Prolonged use of opioid analgesics during pregnancy can cause neonatal opioid withdrawal syndrome; there are no available data in pregnant women to inform a drug associated risk for major birth defects and miscarriage; published studies with morphine use during pregnancy have not reported a clear association with morphine and major birth defects
Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth; the onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of drug by newborn; observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly
Severe fetal bradycardia reported when administered during labor; naloxone may reverse these effects; although there are no reports of fetal bradycardia earlier in pregnancy, it is possible it may occur; drug should be used in pregnancy only if clearly needed, if potential benefit outweighs risk to fetus, and if appropriate measures such as fetal monitoring are taken to detect and manage potential adverse effect on fetus
Labor or delivery
- Opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid induced respiratory depression in neonate; drug is not recommended for use in women during and immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions that temporarily reduce strength, duration, and frequency of uterine contractions; however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor; monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression
Infertility
- Due to effects of androgen deficiency, chronic use of opioids may cause reduced fertility in females and males of reproductive potential; it is not known whether effects on fertility are reversible
Lactation
Morphine is present in breast milk; published lactation studies report variable concentrations of morphine in breast milk with administration of immediate-release morphine to nursing mothers in the early postpartum period with a milk-to-plasma morphine AUC ratio of 2.5:1 measured in one lactation study; however, there is insufficient information to determine effects of morphine on breastfed infant and effects of morphine on milk production; no information is available on effects of drug on breastfed infant or effects of drug on milk production
The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition
Monitor infants exposed to therapy through breast milk for excess sedation and respiratory depression; withdrawal symptoms can occur in breastfed infants when maternal administration of morphine is stopped, or when breastfeeding is stopped
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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| nalbuphine injection - | 20 mg/mL solution |  | |
| nalbuphine injection - | 10 mg/mL solution |  | |
| nalbuphine injection - | 20 mg/mL solution |  | |
| nalbuphine injection - | 10 mg/mL solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
nalbuphine injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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