Home Drug Guide Nalbuphine Hydrochloride

Drug Guide

Generic Name

Nalbuphine Hydrochloride

Brand Names Nubain

Classification

Therapeutic: Analgesic, Opioid

Pharmacological: Mixed opioid agonist-antagonist

FDA Approved Indications

  • Moderate to severe pain

Mechanism of Action

Nalbuphine binds to kappa opioid receptors producing analgesia and sedation, while antagonizing mu opioid receptors, which reduces the risk of respiratory depression associated with mu agonists.

Dosage and Administration

Adult: Typically 10-20 mg IV, IM, or subcutaneously every 3-6 hours as needed. Maximum dose varies based on clinical scenario.

Pediatric: Dose varies; generally 0.2-0.6 mg/kg IV or IM every 3-6 hours. Precise dosing should consider patient age and weight.

Geriatric: Start at lower doses due to increased sensitivity; consult specific guidelines.

Renal Impairment: Adjust dosing carefully; monitor for increased effects or toxicity.

Hepatic Impairment: Use with caution; dose adjustment may be necessary.

Pharmacokinetics

Absorption: Well absorbed intramuscularly and intravenously.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Primarily hepatic metabolism.

Excretion: Renal excretion of unchanged drug and metabolites.

Half Life: Approximately 3 hours.

Contraindications

  • Hypersensitivity to nalbuphine or other opioids.

Precautions

  • Use with caution in respiratory impairment, head injury, increased intracranial pressure, or during labor due to potential effects on fetal or maternal respiratory function. Risk of dependence with prolonged use.

Adverse Reactions - Common

  • Dizziness (Common)
  • Sedation (Common)
  • Nausea or vomiting (Common)
  • Sweating (Common)

Adverse Reactions - Serious

  • Respiratory depression (Rare but serious)
  • Hypotension (Uncommon)
  • Allergic reactions including rash, urticaria (Uncommon)

Drug-Drug Interactions

  • Other CNS depressants, including alcohol, sedatives, and tranquilizers increase sedative effects.
  • Cimetidine and other CYP450 inhibitors may affect metabolism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, pain levels, blood pressure, and level of consciousness.

Diagnoses:

  • Risk for respiratory depression
  • Impaired comfort related to pain

Implementation: Administer doses as prescribed, monitor for adverse effects, and titrate carefully.

Evaluation: Assess relief of pain and monitor for adverse effects, especially respiratory depression.

Patient/Family Teaching

  • Inform about potential side effects such as drowsiness, dizziness, and respiratory depression.
  • Advise on caution when operating machinery or driving.
  • Avoid alcohol and other CNS depressants.

Special Considerations

Black Box Warnings:

  • Potential for opioid dependency and misuse.

Genetic Factors: Genetic variations may affect metabolism and response.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Respiratory depression, sedation, hypotension, coma.

Treatment: Supportive care, respiratory support, naloxone administration if indicated.

Storage and Handling

Storage: Store at controlled room temperature (20-25°C).

Stability: Stable when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.