Nalbuphine

NUBAIN

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Pronunciation: NAL-byoo-feen

Nalbuphine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Nalbuphine ballicule

Nalbuphine NUBAIN mascot mnemonic cartoon — Visual mnemonic: Nalbuphine mascot
**“Newbie’s Nail booth”**
Constricted pupils → opioid
IV route
K → kappa agonist; weak mu partial agonist — the non-DEA-controlled opioid

What it isKappa agonist and mu antagonist; moderate to severe pain and opioid-induced pruritus.

Why this oneA ceiling on respiratory depression, and its mu antagonism relieves opioid itch without reversing analgesia entirely.

What limits itIt precipitates withdrawal in the opioid-dependent. Dysphoria and sedation from kappa agonism.

Nalbuphine molecular structure (skeletal formula) — Molecular structure: Nalbuphine

FDA-approved for

pain (~1979)

Off-label

opioid-induced pruritus

Principal riskPrecipitated withdrawal; dysphoria from kappa agonism

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Addiction/abuse/misuse; life-threatening respiratory depression; profound sedation, respiratory depression, coma, and death with benzodiazepines or other CNS depressants.

FDA dosing	Population	Start	Target	Max
Pain	adult (~70 kg)	10 mg SC/IM/IV q3–6h PRN		20 mg single dose; 160 mg/day
Supplement to balanced anesthesia	adult	0.3–3 mg/kg IV over 10–15 min (induction); 0.25–0.5 mg/kg IV maintenance PRN

Renal Undefined

Hepatic Undefined

May repeat every 3–6 hours as necessary

Instructions

When discontinuing a physically dependent patient, taper by 25–50% every 2–4 days; do not abruptly discontinue
Have an opioid overdose reversal agent (naloxone/nalmefene) and resuscitative equipment available
Inspect visually before administration

Available strengths

sol 100, 200 mg/10 mL
sol 10, 20 mg/mL
inj 10, 20 mg/mL

Contraindications

Significant respiratory depression
Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
Known or suspected GI obstruction, including paralytic ileus

Cautions

Respiratory depression
Serotonin syndrome with serotonergic drugs
Adrenal insufficiency
Severe hypotension
Life-threatening anaphylactoid reactions
Fetal bradycardia in labor

Adverse reactions

Sedation
Sweaty/clammy feeling
Nausea/vomiting
Dizziness/vertigo
Dry mouth
Headache

Pregnancy Insufficient data; extended use can cause neonatal opioid withdrawal; severe fetal bradycardia reported in labor

Lactation Excreted in milk in small amounts (<1% of dose), clinically insignificant; monitor infant for sedation/respiratory depression

Cost

Nalbuphine (NUBAIN)

Strength		#/mo	CostPlus
100 mg/10 mL	sol	per unit	not offered
200 mg/10 mL	sol	per unit	not offered
10 mg/mL	sol	per unit	not offered
20 mg/mL	sol	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Nalbuphine is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry1986

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Self-check

Why can nalbuphine relieve opioid itch?
Mu antagonism.
What can nalbuphine precipitate in opioid-dependent patients?
Withdrawal.