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Opioids/Nalbuphine

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Nalbuphine may prevent your other pain medicine from working.

What might happen:

If you have taken opioid medicines for a while, nalbuphine may cause you to experience withdrawal symptoms.If you have only taken opioid medicines for a short time, and nalbuphine may reduce some of the side effects of your medicine, such as itching or shallow breathing; however, your opioid may not control your pain as well.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together and how long you have been taking an opioid. If your pain gets worse, or if you have withdrawal symptoms such as trouble sleeping, sweating, widened pupils, runny nose, watering eyes, irritability, weakness, muscle aches/twitching/cramps, stomach cramps, hot/cold flashes, sneezing, vomiting, diarrhea, rapid breathing, fast heartbeat, and/or fever, contact your doctor.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

1.Nubain (nalbuphine hydrochloride) US prescribing information. Endo Pharmaceuticals Inc. January, 2005.
2.Wang JJ, Ho ST, Hu OY. Comparison of intravenous nalbuphine infusion versus saline as an adjuvant for epidural morphine. Reg Anesth 1996 May-Jun;21(3):214-8.
3.Wang JJ, Ho ST, Tzeng JI. Comparison of intravenous nalbuphine infusion versus naloxone in the prevention of epidural morphine-related side effects. Reg Anesth Pain Med 1998 Sep-Oct;23(5):479-84.
4.Houlihan KP, Mitchell RG, Flapan AD, Steedman DJ. Excessive morphine requirements after pre-hospital nalbuphine analgesia. J Accid Emerg Med 1999 Jan;16(1):29-31.
5.Robinson N, Burrows N. Excessive morphine requirements after pre-hospital nalbuphine analgesia. J Accid Emerg Med 1999 Sep;16(5):392.
6.Jaffe RS, Moldenhauer CC, Hug CC Jr, Finlayson DC, Tobia V, Kopel ME. Nalbuphine antagonism of fentanyl-induced ventilatory depression: a randomized trial. Anesthesiology 1988 Feb;68(2):254-60.
7.Ramsay JG, Higgs BD, Wynands JE, Robbins R, Townsend GE. Early extubation after high-dose fentanyl anaesthesia for aortocoronary bypass surgery: reversal of respiratory depression with low-dose nalbuphine. Can Anaesth Soc J 1985 Nov;32(6):597-606.
8.Blaise GA, Nugent M, McMichan JC, Durant PA. Side effects of nalbuphine while reversing opioid-induced respiratory depression: report of four cases. Can J Anaesth 1990 Oct;37(7):794-7.
9.Moldenhauer CC, Roach GW, Finlayson DC, Hug CC Jr, Kopel ME, Tobia V, Kelly S. Nalbuphine antagonism of ventilatory depression following high-dose fentanyl anesthesia. Anesthesiology 1985 May;62(5):647-50.
10.Bailey PL, Clark NJ, Pace NL, Stanley TH, East KA, van Vreeswijk H, van de Pol P, Clissold MA, Rozendaal W. Antagonism of postoperative opioid-induced respiratory depression: nalbuphine versus naloxone. Anesth Analg 1987 Nov;66(11):1109-14.
11.Latasch L, Teichmuller T, Dudziak R, Probst S. Antagonisation of fentanyl-induced respiratory depression by nalbuphine. Acta Anaesthesiol Belg 1989;40(1):35-40.
12.Zsigmond EK, Durrani Z, Barabas E, Wang XY, Tran L. Endocrine and hemodynamic effects of antagonism of fentanyl-induced respiratory depression by nalbuphine. Anesth Analg 1987 May;66(5):421-6.
13.Davies GG, From R. A blinded study using nalbuphine for prevention of pruritus induced by epidural fentanyl. Anesthesiology 1988 Nov; 69(5):763-5.
14.Kendrick WD, Woods AM, Daly MY, Birch RF, DiFazio C. Naloxone versus nalbuphine infusion for prophylaxis of epidural morphine-induced pruritus. Anesth Analg 1996 Mar;82(3):641-7.
15.Cohen SE, Ratner EF, Kreitzman TR, Archer JH, Mignano LR. Nalbuphine is better than naloxone for treatment of side effects after epidural morphine. Anesth Analg 1992 Nov;75(5):747-52.
16.Alhashemi JA, Crosby ET, Grodecki W, Duffy PJ, Hull KA, Gallant C. Treatment of intrathecal morphine-induced pruritus following caesarean section. Can J Anaesth 1997 Oct;44(10):1060-5.
17.Parker RK, Holtmann B, White PF. Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone. Anesth Analg 1997 Apr; 84(4):757-63.
18.Henderson SK, Cohen H. Nalbuphine augmentation of analgesia and reversal of side effects following epidural hydromorphone. Anesthesiology 1986 Aug;65(2):216-8.
19.Preston KL, Bigelow GE, Liebson IA. Antagonist effects of nalbuphine in opioid-dependent human volunteers. J Pharmacol Exp Ther 1989 Mar; 248(3):929-37.
20.Hartree C. Caution with nalbuphine in patients on long-term opioids. Palliat Med 2005 Mar;19(2):168.
21.Smith J, Guly H. Nalbuphine and slow release morphine. BMJ 2004 Jun 12; 328(7453):1426.

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