Indications for Nalbuphine HCl Injection:
Pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Pre-op and post-op pain. Pain during labor and delivery. Supplement to balanced anesthesia.
Pain: Individualize. Initially 10mg per 70kg SC, IM, or IV every 3–6hrs as needed. Non-tolerant: max single dose of 20mg; max total daily dose of 160mg. Anesthesia (induction): usual range: 0.3–3mg/kg IV over 10–15mins; (maintenance): usual range: 0.25–0.5mg/kg in single IV administrations as needed.
<18yrs: not established.
Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. Known or suspected GI obstruction, including paralytic ileus.
Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Abuse potential (monitor). Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. MI with nausea/vomiting. Drug abusers. Renal or hepatic impairment. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; avoid; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery. Nursing mothers.
Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. During or within 14 days of MAOIs: not recommended. Avoid concomitant full opioid agonist analgesic. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics.
Sedation, sweaty/clammy, nausea/vomiting, dizziness/vertigo, dry mouth, headache, allergic reactions; respiratory depression, severe hypotension, syncope.
Formerly known under the brand name Nubain.