Nalbuphine HCl

(NAL-byoo-FEEN HIGH-droe-KLOR-ide)

Nubain

Class: Narcotic agonist-antagonist analgesic

 Action 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.

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

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: SC/IM/IV 10 mg/70 kg q 3 to 6 hr prn. Individualize dosage. In nontolerant patients, do not exceed 20 mg/dose or 160 mg/day.

 Interactions

CNS depressants, including barbiturate anesthetics: Increased respiratory and CNS depression. Incompatibilities: Diazepam, pentobarbital, promethazine.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypertension; hypotension; bradycardia; tachycardia; pulmonary edema. CNS: Sedation; dizziness; vertigo; headache. DERM: Urticaria. EENT: Miosis. GI: Nausea; vomiting; constipation; dry mouth. RESP: Respiratory depression. OTHER: Sweaty or clammy feeling.

 Precautions

Pregnancy: Pregnancy category undetermined. Safety (except during labor) is unknown. May cause respiratory depression in neonate; use drug with caution in women delivered of premature infants. Lactation: Undetermined. Children: Not recommended in patients < 18 yr. 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. 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. Renal or hepatic impairment: Duration of action may be prolonged; may need to reduce dose. Sulfite sensitivity: Contains sodium metabisulfite, which may cause allergic-type reactions including anaphylactic symptoms and life-threatening asthma.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Administer via parenteral route only.
• Store in light-resistant container at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain baseline assessments of pain, respiratory rate and level of consciousness. Withhold medication and notify physician if respiratory rate < 10/min.
• For patients receiving opiate agonists (eg, morphine, codeine), assess for signs and symptoms of withdrawal, which may include restlessness, abdominal cramps, nausea, vomiting, lacrimation, piloerection, increased temperature. Check physician’s orders for notes on use of morphine sulfate to relieve withdrawal symptoms.
• Monitor effectiveness of medication by evaluating patient’s pain perception.
• Monitor for sedation. May need to take precautions against falling to ensure patient safety.
• Carefully monitor patients with neurologic injury.
• Monitor for constipation and urinary retention.

OVERDOSAGE: SIGNS & SYMPTOMS   Respiratory depression, hypoxemia, sedation

 Patient/Family Education

• Explain importance of communicating effectiveness of pain relief.
• Tell patient to inform nurse if difficulty breathing, dizziness, drowsiness, or lethargy occurs.
• Explain importance of fall precautions and of asking for assistance with ambulation.
• Emphasize importance of informing caregivers of potential problems, including sedation, dizziness, headache, vertigo, nausea, vomiting, dry mouth, itching, shortness of breath, blurred vision, flushing.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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