Nalbuphine (Nubain)

  1. Class
    Opioid Analgesic
  2. Mechanism of Action
    Activates opiate receptor in limbic system of CNS, analgesic similar to morphine on a milligram for milligram basis, agonist and antagonist properties; may be preferred for chest pain in setting of acute MI as it reduces the myocardial oxygen demand without reducing the blood pressure.
  3. Indications
    Chest pain associated with acute MI; moderate to severe acute pain; pulmonary edema, with or without associated chest pain (morphine remains first line).
  4. Contraindications
    Head injury or undiagnosed abdominal pain, diarrhea caused by poisoning, hypovolemia, hypotension.
  5. Adverse Reactions
    Hypotension, bradycardia, facial flushing, respiratory depression, CNS depression, euphoria, paradoxical CNS stimulation, blurred vision.
  6. Drug Interactions
    CNS depressants may potentiate effects.
  7. How Supplied
    10 mg in 1-mL ampule (10 mg/mL), 20 mg in 1-mL ampule.
  8. Dosage and Administration
    • Adult: 2-5 mg slowly IV; may repeat 2-mg doses PRN to maximum dose of 10 mg.
    • Pediactric: Not recommended
  9. Duration of Action
    • Onset: 2-3 minutes.
    • Peak Effect: variable.
    • Duration: 3-6 hours.
  10. Special Considerations
    Pregnancy safety: Category B. Use with caution in patients with impaired respiratory function. May precipitate withdrawal syndromes in narcotic-dependant patients. Naloxone should be readily available.
  11. Trade Names
Card Set
Nalbuphine (Nubain)
Paramedic Pharmacology