Nurses Compass
Drug Guide
Nalbuphine Hydrochloride
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/ADrug-Herb Interactions
N/ANursing 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.