Nalbuphine Hcl

Indications & Dose:

Note: 3 6 mg IM is equivalent to 10 mg IM morphine

Adult

• Moderate to severe pain.

Adults:

10 to 20 mg S.C., I.M., or I.V. q 3 to 6 hours, p.r.n., or around the clock. Maximum, 160 mg daily.

• Myocardial infarction:

10-30 mg by slow i.v inj, repeat dose 20 mg may be given within 30 minutes if necessary.

• Supplement to balanced anesthesia:

Induction 0.3-3 mg/kg IV administered over 10 15 min period; maintenance 0.25 0.50 mg/kg as required

Children

Up to 0.3mg/Kg repeated once or twice as necessary.

Overdose and treatment

Nalbuphine overdose most commonly causes CNS depression, respiratory depression, and miosis. Other acute toxic effects include hypotension, bradycardia, hypothermia, shock, apnea, cardiopulmonary arrest, circulatory collapse, pulmonary edema, and seizures.

To treat acute overdose, first establish adequate respiratory exchange via a patent airway and ventilation as needed; give an opioid antagonist (naloxone) to reverse respiratory depression, Because the duration of action of nalbuphine is longer than that of naloxone, repeated naloxone dosing is needed. Don’t give naloxone in the absence of significant respiratory or CV depression. Monitor vital signs closely.

Provide symptomatic and supportive treatment such as continued respiratory support and correction of fluid or electrolyte imbalance. Monitor laboratory values, vital signs, and neurologic status closely. 

Contraindications:

Side Effects:

Cautions:

Precautions:

Addictive personality, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, hepatic disease, renal disease, sulfite sensitivity 

Interaction:

Drugs

Barbiturates: Additive respiratory and CNS depression

Cimetidine: Inhibition of narcotic hepatic metabolism; additive CNS effects

Rifampin: May reduce narcotic concentrations and precipitate withdrawal

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Confusion, crying, dizziness, dreams, dysphoria (high doses), euphor-iaj hear he, sedation;  vprjigoCv.-Bradycardia, change in blood pressure, palpitations

EENT: Blurred vision, diplopia, miosis, tinnitus

GI: Anorexia; constipatiofr, cramps: dry mouth, nausea, vomiting

GU: Dysuria, increased urinary output, urinary retention, urinary urgency

RESP: Respiratory depression

SKIN: Bruising, diaphoresis, flushing, pruritus, rash, urticaria

MISC: Flushing, speech difficulty, warmth

Patient And Carer Advice: