Dangerous Drug: Nalbuphine Hydrochloride(nal’ byoo feen)
Nubain
PREGNANCY CATEGORY B
PREGNANCY CATEGORY D
(PROLONGED USE OR WITH HIGH DOSES AT TERM)
Drug class
Opioid agonist-antagonist analgesic
Therapeutic Actions
Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia and sedation but also acts to cause hallucinations and is an antagonist at mu receptors.
Indications
Relief of moderate to severe pain
Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery
Unlabeled use: Prevention and treatment of intrathecal morphine–induced pruritus after cesarean section
Contraindications and Cautions
Contraindicated with hypersensitivity to nalbuphine, sulfites.
Use cautiously with emotionally unstable patients or those with a history of opioid abuse, pregnancy prior to labor (neonatal withdrawal may occur if mothers used drug during pregnancy), labor or delivery (use with caution during delivery of premature infants, who are especially sensitive to respiratory-depressant effects of opioids), bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery (may cause spasm of the sphincter of Oddi), lactation.
Available Forms
Injection—10 mg/mL, 20 mg/mL
Dosages
Adults
• Moderate to severe pain: Usual dose is 10 mg for a 70-kg person IM, IV, or subcutaneously every 3–6 hr as needed. Individualize dosage. In nontolerant patients, the recommended single maximum dose is 20 mg, with a maximum total daily dose of 160 mg. Patients dependent on opioids may experience withdrawal symptoms with administration of nalbuphine; control by small increments of morphine by slow IV administration until relief occurs. If the previous opioid was morphine, meperidine, codeine, or another opioid with similar duration of activity, administer one-fourth the anticipated nalbuphine dose initially, and observe for signs of withdrawal. If no untoward symptoms occur, progressively increase doses until analgesia is obtained.
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