Nalbuphine Hydrochloride

Pronunciation: (NAL-byoo-FEEN HIGH-droe-KLOR-ide) Class: Opioid agonist-antagonist analgesic Trade Names: Nubain - Injection 10 mg/mL - Injection 20mg/mL Nubain (Canada)
Ads by Google

Luxury Rehab Australia

www.sanctuarybb.comDiscreet, Individual and Private Treatment for Addictions

Thailand Rehab $7,000 USD

alcoholrehab.comAsia's Best Drug & Alcohol Rehab. Effective, Affordable, World Class.

Healing pine nut oil

www.pinenutoil.comThe best source for finest quality pine nut oil. Unbeatable prices!

Pharmacology
An opiate analgesic with both narcotic agonist and antagonist actions. Analgesic potency is about equal to that of morphine, and antagonist potency is about 1/ 25 that of naloxone. May cause sphincter of Oddi spasm. Does not increase pulmonary artery pressure, systemic vascular resistance, or myocardial work load.

Pharmacokinetics
Absorption
When nalbuphine is taken orally, it is not as effective for pain relief as when given IM, mainly because of first-pass metabolism in GI and liver. T max is 30 min (IM).

Distribution
Nalbuphine is not bound to plasma proteins. Nalbuphine crosses the placenta.

Metabolism
Metabolized in the liver.

Elimination
Approximately 7% eliminated in urine unchanged and in feces. Plasma t 1/ 2 is 5 h and t 1/ 2 is 2.4 h.

Onset
Onset of IV nalbuphine is 2 to 3 min. Onset of subcutaneous and IM nalbuphine is less than 15 min.

Duration
Duration of analgesic activity is 3 to 6 h.

Indications and Usage

Management of moderate to severe pain; preoperative and postoperative analgesia; supplement to balanced anesthesia; obstetrical analgesia during labor and delivery.

Unlabeled Uses
Prevention and treatment of intrathecal morphine-induced pruritus after cesarean delivery.

Contraindications
Standard considerations.

Dosage and Administration

Adults Subcutaneous / IM / IV 10 mg per 70 kg q 3 to 6 h as needed. Individualize dosage. In nontolerant patients, do not exceed 20mg/dose or 160mg/day.

General Advice

For subcutaneous, IM, or IV administration. Not for intradermal or intra-arterial administration. Do not administer if particulate matter or discoloration noted. Discard any unused medication per institutional policy and procedure. Ensure naloxone, oxygen, and resuscitation and intubation equipment are available for use if needed.

Storage/Stability
Store ampules and vials at controlled room temperature (59 to 86F). Protect from excessive light. Store ampules and vials in carton until contents have been used.
Ads by Google

Luxury Drug Rehab Byron Bay, Australia Treatment for Addictions www.sanctuarybb.com Thailand Rehab $7,000 USD Asia's Best Drug & Alcohol Rehab. Effective, Affordable, World Class. alcoholrehab.com Drug Addiction Forums Seek answers to your drug addiction questions or help those in need. addictionrecoveryguide.org/mboard

Drug Interactions
CNS depressants, including barbiturate anesthetics Increased respiratory and CNS depression.

Incompatibility
Nafcillin, ketorolac.

Laboratory Test Interactions

May interfere with enzymatic methods for detection of opioids, depending on the specificity of test.

Adverse Reactions
Cardiovascular
Bradycardia, hypertension, hypotension, tachycardia (1% or less).

CNS
Sedation (36%); dizziness, vertigo (5%); headache (3%); agitation, confusion, crying, depression, dysphoria, euphoria, faintness, floating feeling, hallucinations, heaviness feeling, hostility, nervousness, numbness, restlessness, seizures, tingling, unreality, unusual dreams (1% or less).

Dermatologic
Flushing (1% or less).

EENT
Blurred vision (1% or less).

GI

Nausea, vomiting (6%); dry mouth (4%); bitter taste, cramps, dyspepsia (1% or less).

Genitourinary
Urinary urgency (1% or less).

Hypersensitivity
Anaphylactic or anaphylactoid and other hypersensitivity reactions (including shock, respiratory distress, respiratory arrest, bradycardia, cardiac arrest, hypotension, or laryngeal edema), stridor, bronchospasm, wheezing, edema, rash, pruritus, nausea, vomiting, diaphoresis, weakness, shakiness (1% or less).

Local
Injection site reactions including burning, hot sensations, pain, redness, swelling (postmarketing).

Respiratory
Pulmonary edema (postmarketing).

Miscellaneous
Sweaty/clammy feeling (9%); speech difficulty, warmth (1% or less).
Ads by Google

Luxury Drug Rehab Byron Bay, Australia Treatment for Addictions www.sanctuarybb.com Thailand Rehab $7,000 USD Asia's Best Drug & Alcohol Rehab. Effective, Affordable, World Class. alcoholrehab.com Pine nut oil for health This new healing oil is absolutely amazing and unique. Learn more now! www.pinenutoil.com

Precautions
Pregnancy
Category B .

Lactation
Excreted in breast milk.

Children
Safety and efficacy not established.

Renal Function
Duration of action may be prolonged in patients with renal function impairment; may need to reduce dose.

Hepatic Function
Duration of action may be prolonged in patients with hepatic function impairment; may need to reduce dose.

Special Risk Patients

Use drug with caution in patients with impaired respiration, head injury, increased intracranial pressure, or MI with nausea or vomiting, and in patients about to undergo biliary tract surgery.

Sulfite Sensitivity
Contains sodium metabisulfite, which may cause allergic-type reactions including anaphylactic symptoms and life-threatening asthma.

Dependence
Low abuse potential; however, withdrawal symptoms can occur after long-term use. Use drug with caution in patients who are emotionally unstable or have history of narcotic abuse.

Opiate-dependent patients
Nalbuphine can precipitate withdrawal; small doses of morphine can be given to relieve discomfort. If patient has received morphine, meperidine, codeine, or other opiate of similar duration, give 25% of normal nalbuphine dose first. Observe for signs of withdrawal and increase nalbuphine dose slowly.

Overdosage
Symptoms
Respiratory depression, hypoxemia, sedation.

Patient Information

Advise patient or caregiver that medication will usually be prepared and administered by a health care provider in a health care setting. Caution patient or caregiver that medication may be habit forming and, if used at home, to use exactly as prescribed and not to change the dose or discontinue therapy unless advised by health care provider. Advise patient or caregiver to notify health care provider if medication does not adequately control pain. Advise patient or caregiver that if medication needs to be discontinued after prolonged use that it will usually slowly be withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal. Advise patient or caregiver to notify health care provider if any of the following occur: excessive sedation or drowsiness; slow or shallow breathing; low BP; slow heart rate; severe constipation. Instruct patient to get up slowly from lying or sitting position and to avoid sudden position changes to prevent postural hypotension. Advise patient to report dizziness with position changes to health care provider. Caution patient that hot tubs and hot showers or baths may make dizziness worse. Caution patient that drug may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined. Caution patient to avoid alcohol and other CNS depressant medications while using this medication. Copyright 2009 Wolters Kluwer Health.