Narcotic analgesics:

Indications for Nalbuphine HCl Injection:

Pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Pre-op and post-op pain. Pain during labor and delivery. Supplement to balanced anesthesia.

Adult Dosage:

Pain: Individualize. Initially 10mg per 70kg SC, IM, or IV every 3–6hrs as needed. Non-tolerant: max single dose of 20mg; max total daily dose of 160mg. Anesthesia (induction): usual range: 0.3–3mg/kg IV over 10–15mins; (maintenance): usual range: 0.25–0.5mg/kg in single IV administrations as needed.

Children Dosage:

<18yrs: not established.

Nalbuphine HCl Injection Contraindications:

Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected GI obstruction, including paralytic ileus.

Nalbuphine HCl Injection Warnings/Precautions:

Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Abuse potential (monitor). Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. MI with nausea/vomiting. Drug abusers. Renal or hepatic impairment. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; avoid; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery. Nursing mothers.

Nalbuphine HCl Injection Classification:

Opioid (agonist-antagonist).

Nalbuphine HCl Injection Interactions:

Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. During or within 14 days of MAOIs: not recommended. Avoid concomitant full opioid agonist analgesic. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics.

Adverse Reactions:

Sedation, sweaty/clammy, nausea/vomiting, dizziness/vertigo, dry mouth, headache, allergic reactions; respiratory depression, severe hypotension, syncope.

Note:

Formerly known under the brand name Nubain.

How Supplied:

Contact supplier.