nalbuphine (Nubain)

Introduction

Tradename: Nubain.

Indications

relief of moderate to severe pain

Dosage

• 10 mg IV/IM/SC every 3-6 hours
• 10 mg/70 kg IV/IM/SC every 3-6 hours
• maximum: 20 mg/dose
• maximum daily dose 160 mg

Injection: 10 mg/mL (1 mL), 20 mg/mL (1 mL)

Pharmacokinetics

• onset of action:
  • IM/SC: < 15 minutes
  • IV: 2-3 minutes
• peak effect:
  • IM: 30 minutes
  • IV: 1-3 minutes

elimination via liver

Adverse effects

• common (> 10%)
  • drowsiness, histamine release, sedation
• less common (1-10%)
  • rash, hypotension, anorexia, nausea/vomiting, dry mouth, dizziness, headache, pain at site of injection, weakness, sweaty or clammy feeling
• uncommon (< 1%)
  • blurred vision, biliary spasm, decreased urination, toxic megacolon, depression, hypertension, hallucinations, tachycardia, confusion, paradoxical CNS stimulation, shortness of breath, respiratory depression, GI irritation, nervousness, restlessness, nightmares, ureteral spasm, insomnia

Overdose:

• airway support
• naloxone 2 mg IV (0.01 mg/kg for children)
• may repeat naloxone as needed up to 10 mg

• drug adverse effects of opiates
• drug adverse effects of psychotropic agents
• drug adverse effects of sedatives

Drug interactions

• barbiturates

• drug interaction(s) of benzodiazepine with opiates
• drug interaction(s) of antidepressant with opiates
• drug interaction(s) of Z-drugs with opiates
• drug interaction(s) of alcoholic beverage with opiates
• drug interaction(s) of pregabalin with opiates
• drug interaction(s) of gabapentin with opiates

More general terms

• mixed opioid agonist-antagonist

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=30197
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=4419
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5311304
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5284593
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=31804