Download Drug Information Summary - Nalbuphine

DRUG INFORMATION SUMMARY SHEET: NALBUPHINE
Nalbuphine (Nubain) is in the class of analgesic medications. It is an OPIOID
medication and has MIXED AGONIST/ANTAGONIST activity. Specifically, it has partial
mu antagonism and full kappa agonism.
Both the partial mu antagonism and the kappa agonism are useful for opioid-induced
itch (OII), a phenomenon which has both central and peripheral mechanisms. (The
commonly used option, diphenhydramine or Benadryl, is sedating, and potentially
dangerous in the elderly.)
Nalbuphine also has analgesic properties on its own. It is equianalgesic to morphine,
so doses administered at a time are anywhere form 1-4mg in an adult. Anesthesia
providers may use higher doses to achieve higher levels of analgesia. When used with
full mu agonist opioids (morphine, hydromorphone, fentanyl), its analgesic effect is
negligible.
The adverse reactions/side effects are similar to other opioids:
- hypersensitivity to drug/class/components
- caution in renal failure
- caution in elderly
Pregnancy: Class B
Lactation: Safety unknown.
Nalbuphine can be given IV/IM/SC.
Vials come in concentrations of 1mg/ml, 10mg/ml and 20mg/ml.
For OII, we would initiate an order: Nalbuphine 2-4mg IV q3H PRN (itch).
***As of September 2012, the manufacturers for Nubain have announced a shortage,
and state that delivery and recovery may occur over December 2012.
Naidu, Ramana. UCSF Dept of Anesthesiology & Pain Management. September 17, 2012.