Action

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

Availability

Injection: 10 mg/ml, 20 mg/ml

Indications and dosages

➣ Moderate to severe pain

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

➣ Adjunct to balanced anesthesia

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

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

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

• history of substance abuse or dependence

• pregnant or breastfeeding patients

• children.

Administration

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

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

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

Adverse reactions

CNS: dizziness, sedation, headache, vertigo

CV: hypertension, hypotension, tachycardia, bradycardia

EENT: miosis

GI: nausea, vomiting, dry mouth

Respiratory: dyspnea, respiratory depression

Skin: sweating, clammy skin

Other: hypersensitivity reactions including anaphylaxis

Interactions

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

Drug-diagnostic tests. Amylase, lipase: increased levels

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

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

Patient monitoring

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

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

Watch for hypersensitivity reactions, including anaphylaxis.

Patient teaching

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

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

• Advise patient to consult prescriber before taking herbs.

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

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