Nubain

Generic name: Nalbuphine
Drug class: Opioids (narcotic analgesics)

Usage of Nubain

Nalbuphine injection is used to relieve moderate to severe pain. It may also be given before and after a surgery or with a general anesthesia before an operation. It may also be used to relieve pain while giving birth.

Nalbuphine belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

When a nalbuphine injection is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only with your doctor's prescription.

Nubain side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Rare

Chest pain or discomfort

difficult or labored breathing

difficulty with swallowing

fainting

false beliefs that cannot be changed by facts

fast, pounding, or irregular heartbeat or pulse

puffiness or swelling of the eyelids or around the eyes, face, lips or tongue

redness of the face, neck, arms, and occasionally, upper chest

seeing, hearing, or feeling things that are not there

sense of detachment from self or body

slow or irregular heartbeat

Incidence not known

Blue lips and fingernails

convulsions

coughing that sometimes produces a pink frothy sputum

decrease in consciousness

difficult, fast, or noisy breathing, sometimes with wheezing

fear or nervousness

fever

hyperventilation

increased sweating

loss of bladder control

muscle spasm or jerking of all extremities

pale skin

shakiness in the legs, arms, hands, or feet

sleepiness or unusual drowsiness

stomach pain

sudden loss of consciousness

swelling in the legs and ankles

trembling or shaking of the hands or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Dizziness or lightheadedness

drowsiness

feeling of constant movement of self or surroundings

nausea

relaxed and calm

sensation of spinning

sleepiness

sweaty, clammy skin

vomiting

Less common

Dry mouth

Headache

Rare

Acid or sour stomach

aggressive or angry

belching

blurred vision

burning

changes in speech

confusion

cough

discouragement

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

dysphoria

excessive crying

false or unusual sense of well-being

feeling of heaviness

feeling of warmth

feeling sad or empty

floating feeling

frequent strong or increased urge to urinate

headache

heartburn

hives or welts, itching skin, rash

indigestion

irritability

lack of appetite

loss of interest or pleasure

numbness

pounding in the ears

restlessness

slow or fast heartbeat

stomach discomfort or upset

tiredness

trouble concentrating

trouble sleeping

tingling feeling of unreality

unusual tiredness or weakness

Incidence not known

Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Before taking Nubain

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of nalbuphine injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of Nubain® in the elderly. However, elderly patients are more likely to have kidney, liver, heart, or lung problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

No information is available on the relationship of age to the effects of nalbuphine injection in geriatric patients.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Nalmefene

Naltrexone

Safinamide

Samidorphan

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acepromazine

Alfentanil

Almotriptan

Alprazolam

Amifampridine

Amineptine

Amitriptyline

Amobarbital

Amoxapine

Amphetamine

Aripiprazole

Asenapine

Baclofen

Benperidol

Benzhydrocodone

Benzphetamine

Bromazepam

Bromopride

Butorphanol

Calcium Oxybate

Cannabidiol

Cannabis

Carbamazepine

Carbinoxamine

Carphenazine

Cetirizine

Chloral Hydrate

Chlordiazepoxide

Chlorpheniramine

Chlorpromazine

Chlorzoxazone

Citalopram

Clobazam

Clomipramine

Clonazepam

Clopidogrel

Clorazepate

Clozapine

Cocaine

Codeine

Daridorexant

Desipramine

Desmopressin

Desvenlafaxine

Dexmedetomidine

Dextroamphetamine

Dextromethorphan

Dezocine

Diazepam

Dibenzepin

Dichloralphenazone

Difenoxin

Diphenhydramine

Diphenoxylate

Dolasetron

Donepezil

Doxepin

Droperidol

Duloxetine

Eletriptan

Enflurane

Escitalopram

Esketamine

Estazolam

Eszopiclone

Ethchlorvynol

Ethopropazine

Ethylmorphine

Fenfluramine

Fentanyl

Flibanserin

Fluoxetine

Fluphenazine

Flurazepam

Fluspirilene

Fluvoxamine

Fospropofol

Frovatriptan

Gabapentin

Gabapentin Enacarbil

Gepirone

Granisetron

Halazepam

Haloperidol

Halothane

Hexobarbital

Hydrocodone

Hydromorphone

Hydroxyamphetamine

Hydroxytryptophan

Hydroxyzine

Imipramine

Iproniazid

Isocarboxazid

Isoflurane

Ketamine

Ketazolam

Ketobemidone

Lacosamide

Lasmiditan

Lemborexant

Levocetirizine

Levomilnacipran

Levorphanol

Linezolid

Lisdexamfetamine

Lithium

Lofepramine

Lofexidine

Lorazepam

Lorcaserin

Loxapine

Magnesium Oxybate

Meclizine

Melitracen

Melperone

Meperidine

Mephobarbital

Meprobamate

Meptazinol

Mesoridazine

Metaxalone

Methadone

Methamphetamine

Methdilazine

Methocarbamol

Methohexital

Methotrimeprazine

Methylene Blue

Metoclopramide

Midazolam

Milnacipran

Mirtazapine

Moclobemide

Molindone

Moricizine

Morphine

Naratriptan

Nefazodone

Nialamide

Nicomorphine

Nitrazepam

Nitrous Oxide

Nortriptyline

Olanzapine

Ondansetron

Opipramol

Opium

Opium Alkaloids

Orphenadrine

Oxazepam

Oxycodone

Oxymorphone

Ozanimod

Palonosetron

Papaveretum

Paregoric

Paroxetine

Pentazocine

Pentobarbital

Perampanel

Perazine

Periciazine

Perphenazine

Phenelzine

Phenobarbital

Pimozide

Piperacetazine

Pipotiazine

Piritramide

Potassium Oxybate

Prazepam

Pregabalin

Primidone

Procarbazine

Prochlorperazine

Promazine

Promethazine

Propofol

Protriptyline

Quazepam

Quetiapine

Ramelteon

Rasagiline

Remifentanil

Remimazolam

Remoxipride

Rizatriptan

Ropeginterferon Alfa-2b-njft

Scopolamine

Secobarbital

Selegiline

Sertindole

Sertraline

Sibutramine

Sodium Oxybate

St John's Wort

Sufentanil

Sulpiride

Sumatriptan

Suvorexant

Tapentadol

Temazepam

Thiethylperazine

Thiopental

Thiopropazate

Thioridazine

Tianeptine

Tilidine

Tizanidine

Tolonium Chloride

Topiramate

Tramadol

Tranylcypromine

Trazodone

Triazolam

Trifluoperazine

Trifluperidol

Triflupromazine

Trimeprazine

Trimipramine

Tryptophan

Venlafaxine

Vilazodone

Vortioxetine

Zaleplon

Ziprasidone

Zolpidem

Zopiclone

Zotepine

Zuranolone

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Ethanol

Relate drugs

How to use Nubain

A nurse or other trained health professional will give you this medicine. This medicine is given as a shot under your skin or into a muscle or a vein.

Warnings

It is very important that your doctor check your progress while you are receiving this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to use it.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the other medicines listed above while you are using this medicine.

Symptoms of an overdose include extreme dizziness or weakness, slow heartbeat or breathing, seizures, trouble breathing, and cold, clammy skin. Call your doctor right away if you notice these symptoms.

This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia). Your doctor may decrease your dose if you have sleep apnea (stop breathing for short periods during sleep) while using this medicine.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve dizziness or lightheadedness.

This medicine may make you dizzy, drowsy, or lightheaded. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

Do not change your dose or suddenly stop using this medicine without first checking with your doctor. Your doctor may want to gradually reduce the amount of medicine given to you before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

Using this medicine while you are pregnant may cause neonatal withdrawal syndrome in your newborn babies. Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, a high-pitched cry, irritability, shakiness or tremors, weight loss, vomiting, or fails to gain weight.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

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