nalbuphine (Rx)

Brand and Other Names:Nubain
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Dosing & Uses

AdultPediatric

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

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 20mg/mL

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

and nalbuphine

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            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 (51)

            • 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.

            • 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.

            • 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.

            • 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 (183)

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

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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

            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

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            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.

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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

            BRAND FORM. UNIT PRICE PILL IMAGE
            nalbuphine injection
            -
            20 mg/mL solution
            nalbuphine injection
            -
            10 mg/mL solution

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            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) 2021 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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.
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            • 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.
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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.