Names and pronunciation
(nal′byoo-feen) Nubain
PDF page 928
Loading InternPractice…
Drug reference
(nal′byoo-feen) Nubain
PDF page 928
Func. class.: Opioid analgesic
PDF page 928
Chem. class.: Synthetic opioid ago- nist, antagonist
PDF page 928
Do not confuse: nalbuphine/naloxone
PDF page 928
ACTION: Depresses pain impulse transmission by interacting with opioid receptors
PDF page 928
USES: Moderate to severe pain, sup- plement to anesthesia, sedation prior to surgery
PDF page 928
CONTRAINDICATIONS: Hyper- sensitivity to this product or parabens, addiction (opiate) Precautions: Pregnancy, breastfeeding, addictive personality, increased intracra- nial pressure, MI (acute), severe heart disease, respiratory depression, renal/ hepatic disease, bowel impaction, abrupt discontinuation
PDF page 928
Black Box Warning: Coadministration with other CNS depressants, respiratory depression Black Box Warning: Increase: effects with other CNS depressants—alcohol, opiates, sedative/hypnotics, antipsychot- ics, skeletal muscle relaxants, avoid us- ing together Increase: severe reactions—MAOIs; decrease dose to 25% Black Box Warning: Increase: serotonin syndrome risk SSRIs, SNRIs, TCAs, some antiemetics, antimigraine agents, MAOIs, monitor for serotonin syndrome Drug/Herb Increase: CNS depression—kava, vale- rian, hops, chamomile Increase: serotonin syndrome risk St. John’s wort, monitor closely Black Box Warning: Withdrawal reac- tions in opiate-dependent individuals: PE, vascular occlusion; abscesses, ulcera- tions, nausea, vomiting, seizures • CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil re- action • Allergic reactions: rash, urticaria • Monitor for serotonin syndrome in those taking serotonergic drugs • Monitor for adrenal insufficiency (rare): nausea, vomiting, weakness, hypotension, dizziness; if confirmed, treat with cortico- steroids and slowly withdraw opiates Black Box Warning: Avoid coadmin- istration with other CNS depres- sants: coadministration increases the risk for respiratory depression, low B/P, and death Black Box Warning: Respiratory dys- function: respiratory depression, char- acter, rate, rhythm; notify prescriber if respirations are <10/min, respiratory depression may be fatal • Pregnancy/breastfeeding: use only if clearly needed, labor use can result in fatal bradycardia, monitor closely; if used in long-term pregnancy, neonatal with- drawal syndrome may occur; cautious use in breastfeeding Black Box Warning: To avoid use with CNS depressants, alcohol, benzodiaz- epines, and notify prescriber of unre- sponsiveness, trouble breathing • To avoid driving, operating machinery if drowsiness occurs, to have help with activities to prevent falls at home if dizzy, drowsy • To use sugarless gum or candy and good oral hygiene for dry mouth
PDF pages 928, 929
SIDE EFFECTS CNS: Drowsiness, dizziness, confu- sion, headache, sedation CV: Bradycardia, change in B/P EENT: Blurred vision GI: Nausea, vomiting, constipation, xerostomia, bitter taste INTEG: Diaphoresis, pruritus RESP: Respiratory depression
PDF page 928
INTERACTIONS
PDF page 928
TREATMENT OF OVERDOSE: Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors
PDF page 929
DOSAGE AND ROUTES Analgesic (nonopioid tolerant) • Adult: SUBCUT/IM/IV 10 mg q3-6hr prn (based on 70-kg body weight), max 160 mg/day; max 20 mg/dose if opiate naïve • Child: SUBCUT/IM/IV 0.1-0.15 mg/kg q3-6hr, max 20 mg/dose, 160 mg/day Balanced anesthesia adjunct • Adult: IV 0.3-3 mg/kg given over 10- 15 min; may give 0.25-0.5 mg/kg as needed for maintenance
PDF page 928
Available forms: solution for inj 10, 20 mg/mL
PDF page 928
Administer: • With antiemetic if nausea, vomiting occur • When pain beginning to return; deter- mine dosage interval by response • Store in light-resistant area at room temperature IM route • IM deep in large muscle mass, rotate inj sites, protect from light Direct IV route • Undiluted ≤10 mg over 2-3 min into free-flowing IV line of D5W, NS, or LR SUBCUT route • Rotate injection sites, protect from light
PDF page 928
Assess: • Pain: type, location, intensity before and 30 min after administration; titrate upward with 25%-50% until 50% of pain reduced; need for pain medication by pain sedation scoring, can repeat if initial dose is not ad- equately effective, not for long-term use • Bowel status; constipation is common; may need laxative or stool softener
PDF page 929
Evaluate: • Therapeutic response: decrease in pain without respiratory depression
PDF page 929
CLINICAL CONSIDERATIONS
PDF page 929
Patient and caregiver information: • That physical dependency may result from long-term use • That withdrawal symptoms may oc- cur: nausea, vomiting, cramps, fever, faintness, anorexia, profuse sweating, twitching; without treatment symptoms resolve in 5-14 days, chronic abstinence syndrome may last 2-6 mo • To report all OTC/Rx/herbals/supple- ments taken • To increase bulk water in diet, or add stool softeners for constipation • That naloxone may be used in overdose • To report troubled, slowed breathing; symptoms of serotonin syndrome; aller- gic reactions N
PDF page 929
PHARMACOKINETICS IV: Onset rapid, peak 2-3 min, duration 3-6 hr; IM/SUBCUT: Onset up to 15 min, peak 10-15 min, duration 3-6 hr metabolized by liver, excreted by kidneys, half-life 5 hr
PDF page 928
• Adult: SUBCUT/IM/IV 10 mg q3-6hr prn (based on 70-kg body weight), max 160 mg/day; max 20 mg/dose if opiate naïve
PDF page 928
• Adult: IV 0.3-3 mg/kg given over 10- 15 min; may give 0.25-0.5 mg/kg as needed for maintenance
PDF page 928