Contraindications of Nalbuphine Hydrochloride

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Nalbuphine hydrochloride is a potent synthetic agonist-antagonist opioid, also known by the brand name Nubain. Nalbuphine hydrochloride is given for analgesia (pain relief) either by intramuscular or intravenous injection, or by oral administration. Nalbuphine hydrochloride acts on mu, kappa, and delta opioid receptors in order to intercept pain signals in the central nervous system.

Contraindications of nalbuphine hydrochloride include recent or concurrent use of the opioid agonist class of drugs to which morphine belongs. Patients who have been on one of these drugs must have a period of 1-2 days during which they are drug free before they can safely begin taking nalbuphine hydrochloride. Otherwise, patients might experience withdrawal symptoms or reduced efficiency of the new medication.

Nalbuphine hydrochloride can have a synergistic effect with sedatives or alcohol.

Other drugs that may interact with nalbuphine hydrochloride and thus require monitoring during use include other analgesics, ammonium chloride, antipsychotic drugs, CNS depressants, amphetamines, selective serotonin reuptake inhibitor antidepressants (SSRIs), succinylcholine, and thiazide diuretics. Several herbal remedies are also contraindicated, including valerian, St. John’s wort, java java, and gotu kola.

One of the contraindications of nalbuphine hydrochloride is sulfite sensitivity. Thus, patients with a history of allergic reactions to sulfites or to nalbuphine hydrochloride itself should not take nalbuphine hydrochloride.

All opioid drugs have many potential side effects and should be used with caution in certain patients, even if there are not any specific contraindications of nalbuphine hydrochloride use for these patients. It can lower the blood pressure, and thus should be used with caution in patients who have hypotension or cardiovascular disease. It depresses respiratory function (though less than other drugs in its class) and can be dangerous in patients with underlying lung disease, such as emphysema. Other patients who should use nalbuphine hydrochloride with caution include those with adrenal insufficiency (e.g. Addison’s disease), biliary tract impairment, recent head trauma, decreased liver or kidney function, morbid obesity, an enlarged prostate, or a dysfunctional thyroid.

Elderly patients may have increased side effects and should be started on a lower dose. Nalbuphine hydrochloride has not been tested in children. This drug should be used with caution in pregnant women (its use can decrease fetal heartbeat during delivery) and breastfeeding women (the drug enters breast milk). Patients taking nalbuphine hydrochloride for extended periods may develop physical dependence, leading to withdrawal symptoms upon cessation of drug use. Because of its addictive nature, nalbuphine hydrochloride should be given with caution to patients with a history of drug abuse.

Gutstein HB, Akil H. “Opioid Analgesics,” Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 11th Edition, McGraw-Hill, 2006.

“Nalbuphine” drug monograph, McGraw-Hill Access Medicine. http://www.accessmedicine.com/drugContent.aspx?mid=6621

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