nalbuphine (Nubain)

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Introduction

Tradename: Nubain.

Indications

relief of moderate to severe pain
relief of cough in patients with idiopathic pulmonary fibrosis

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

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

Drug interactions

barbiturates

More general terms

mixed opioid agonist-antagonist

References

↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
↑ Molyneaux PL, Mogulkoc N, Gunen H et al Oral Nalbuphine in Idiopathic Pulmonary Fibrosis-Associated Cough: The CORAL Randomized Clinical Trial. JAMA. 2026 Jan 22:e2526179. PMID: https://pubmed.ncbi.nlm.nih.gov/41569557 https://jamanetwork.com/journals/jama/fullarticle/2844186

Database

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