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Nalbuphine Disease Interactions

There are 15 disease interactions with nalbuphine.

Major

Narcotic analgesics (applies to nalbuphine) impaired GI motility

Major Potential Hazard, Low plausibility. Applicable conditions: Constipation, Gastrointestinal Obstruction, Inflammatory Bowel Disease, Intestinal Anastomoses

Narcotic (opioid) analgesic agents increase smooth muscle tone in the gastrointestinal tract and decrease peristalsis, which can lead to elevated intraluminal pressure, spasm, and constipation following prolonged use. In patients with severe or acute inflammatory bowel disease, the decrease in colonic motility may induce toxic megacolon. Therapy with opioids should be administered cautiously in patients with gastrointestinal obstruction, constipation, inflammatory bowel disease, or recent gastrointestinal tract surgery. Gastrointestinal effects appear to be the most pronounced with morphine.

References

  1. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  2. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  3. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  5. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  6. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  7. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  8. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  9. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  10. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  11. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  13. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  15. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  16. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  17. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  18. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  19. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  20. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  21. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  22. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  23. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  24. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  25. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  26. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  27. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 27 references
Major

Narcotic analgesics (applies to nalbuphine) infectious diarrhea

Major Potential Hazard, Low plausibility. Applicable conditions: Infectious Diarrhea/Enterocolitis/Gastroenteritis

Narcotic (opioid) analgesic agents may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella, Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. These agents decrease gastrointestinal motility, which may delay the excretion of infective gastroenteric organisms and/or their toxins. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. Therapy with opioids should be avoided or administered cautiously in patients with infectious diarrhea, particularly that due to pseudomembranous enterocolitis or enterotoxin-producing bacteria or if accompanied by high fever, pus, or blood in the stool.

References

  1. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  2. Bellville JW, Forrest WH, Elashoff J, Laska E "Evaluating side effects of analgesics in a cooperative clinical study." Clin Pharmacol Ther 9 (1968): 303-13
  3. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  5. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  6. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  7. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  8. White MJ, Berghausen EJ, Dumont SW, Tsueda K, Schroeder JA, Vogel RL, Heine MF, Huang KC "Side effects during continuous epidural infusion of morphine and fentanyl." Can J Anaesth 39 (1992): 576-82
  9. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  10. Thorn SE, Wattwil M, Kallander A "Effects of epidural morphine and epidural bupivacaine on gastroduodenal motility during the fasted state and after food intake." Acta Anaesthesiol Scand 38 (1994): 57-62
  11. Bennett MWR, Shah MV, Bembridge JL "A comparison of the effect on gastric emptying of alfentanil or morphine given during anaesthesia for minor surgery." Anaesthesia 49 (1994): 155-6
  12. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  13. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  14. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  15. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  16. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  17. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  18. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  19. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  20. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  21. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  22. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  23. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  24. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  25. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  26. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  27. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 27 references
Major

Narcotic analgesics (applies to nalbuphine) liver disease

Major Potential Hazard, High plausibility.

Narcotic (opioid) analgesic agents are extensively metabolized by the liver, and several of them (e.g., codeine, hydrocodone, meperidine, methadone, morphine, propoxyphene) have active metabolites that are further converted to inactive substances. The serum concentrations of these agents and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with liver disease. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. Yue QY, Hasselstrom J, Svensson JO, Sawe J "Pharmacokinetics of codeine and its metabolites in Caucasian healthy volunteers: comparisons between extensive and poor hydroxylators of debrisoquine." Br J Clin Pharmacol 31 (1991): 635-42
  2. Pond SM, Tong T, Benowitz NL, et al. "Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects." Clin Pharmacol Ther 30 (1981): 183-8
  3. Neal EA, Meffin PJ, Gregory PB, Blaschke TF "Enhanced bioavailability and decreased clearance of analgesics in patients with cirrhosis." Gastroenterology 77 (1979): 96-102
  4. Bower S, Sear JW, Roy RC, Carter RF "Effects of different hepatic pathologies on disposition of alfentanil in anaesthetized patients." Br J Anaesth 68 (1992): 462-5
  5. Parab PV, Ritschel WA, Coyle DE, et al. "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  6. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  7. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  8. Mazoit J-X, Sandouk P, Zetlaoui P, Scherrmann J-M "Pharmacokinetics of unchanged morphine in normal and cirrhotic subjects." Anesth Analg 66 (1987): 293-8
  9. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
  10. Osborne R, Joel S, Trew D, Slevin M "Morphine and metabolite behavior after different routes of morphine administration: demonstration of the importance of the active metabolite morphine-6-glucoronide." Clin Pharmacol Ther 47 (1990): 12-9
  11. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  12. Gram LF, Schou J, Way WL, et al. "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  13. Yun CH, Wood M, Wood AJ, Guengerich FP "Identification of the pharmacogenetic determinants of alfentanil metabolism: cytochrome P-450 3A4: an explanation of the variable elimination clearance." Anesthesiology 77 (1992): 467-74
  14. Cone EJ, Darwin WD, Gorodetzky CW "Comparative metabolism of codeine in man, rat, dog, guinea-pig and rabbit: identification of four new metabolites." J Pharm Pharmacol 31 (1979): 314-7
  15. McHorse TS, Klotz U, Wilkinson G, Schenker S "Impaired elimination of meperidine in patients with liver disease." Trans Assoc Am Physicians 87 (1974): 281-7
  16. Hasselstrom J, Eriksson S, Persson A, Rane A, Svensson JO, Sawe J "The metabolism and bioavailability of morphine in patients with severe liver cirrhosis." Br J Clin Pharmacol 29 (1990): 289-97
  17. Novick DM, Kreek MJ, Arns PA, et al. "Effect of severe alcoholic liver disease on the disposition of methadone in maintenance patients." Alcohol Clin Exp Res 9 (1985): 349
  18. Kreek MJ, Fanizza AM, et al. "Methadone disposition in patients with chronic liver disease." Clin Pharmacol Ther 30 (1981): 353-62
  19. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  20. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  21. Goromaru T, Matsuura H, Yoshimura N, Miyawaki T, Sameshima T, Miyao J, Furuta T, Baba S "Identification and quantitative determination of fentanyl metabolites in patients by gas chromatography--mass spectrometry." Anesthesiology 61 (1984): 73-7
  22. Haberer JP, Schoeffler P, Couderc E, Duvaldestin P "Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis." Br J Anaesth 54 (1982): 1267-70
  23. McClain DA, Hug CC, Jr "Intravenous fentanyl kinetics." Clin Pharmacol Ther 28 (1980): 106-14
  24. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  25. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  26. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  27. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  28. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  29. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  30. Otton SV, Schadel M, Cheung SW, Kaplan HL, Busto UE, Sellers EM "CYP2D6 phenotype determines the metabolic conversion of hydrocodone to hydromorphone." Clin Pharmacol Ther 54 (1993): 463-72
  31. Cone EJ, Darwin WD, Gorodetzky CW, Tan T "Comparative metabolism of hydrocodone in man, rat, guinea pig, rabbit, and dog." Drug Metab Dispos 6 (1978): 488-93
  32. Hasselstrom J, Sawe J "Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations." Clin Pharmacokinet 24 (1993): 344-54
  33. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  34. Giacomini KM, Giacomini JC, Gibson TP, Levy G "Propoxyphene and norpropoxyphene plasma concentrations after oral propoxyphene in cirrhotic patients with and without surgically constructed portacaval shunt." Clin Pharmacol Ther 28 (1980): 417-24
  35. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  36. Chen ZR, Somogy AA, Reynolds G, Bochner F "Disposition and metabolism of codeine after single and chronic doses in one poor and seven extensive metabolisers." Br J Clin Pharmacol 31 (1991): 381-90
  37. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  38. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  39. Hagen N, Thirlwell MP, Dhaliwal HS, Babul N, Harsanyi Z, Darke AC "Steady-state pharmacokinetics of hydromorphone and hydromorphone-3-glucuronide in cancer patients after immediate and controlled-release hydromorphone." J Clin Pharmacol 35 (1995): 37-44
  40. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  41. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  42. Beckett AH, Vaughan DP, Essien EE "N-Oxidation--an important route in the metabolism of methadone in man." J Pharm Pharmacol 24 (1972): 244
  43. Beckett AH, Taylor JF, Casy AF, Hassan MM "The biotransformation of methadone in man: synthesis and identification of a major metabolite." J Pharm Pharmacol 20 (1968): 754-62
  44. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  45. Dershwitz M, Randel GI, Rosow CE, Fragen RJ, Connors PM, Librojo ES, Shaw DL, Peng AW, Jamerson BD "Initial clinical experience with remifentanil, a new opioid metabolized by esterases." Anesth Analg 81 (1995): 619-23
  46. Dershwitz M, Hoke JF, Rosow CE, Michalowski P, Connors PM, Muir KT, Dienstag JL "Pharmacokinetics and pharmacodynamics of remifentanil in volunteer subjects with severe liver disease." Anesthesiology 84 (1996): 812-20
  47. Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT "Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery." Anesthesiology 79 (1993): 893-903
  48. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  49. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  50. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  51. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  52. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  53. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  54. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  55. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  56. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  57. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  58. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  59. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 59 references
Major

Narcotic analgesics (applies to nalbuphine) prematurity

Major Potential Hazard, High plausibility. Applicable conditions: Prematurity/Underweight in Infancy

The use of narcotic (opioid) analgesic agents is contraindicated in premature infants. These agents may cross the immature blood-brain barrier to a greater extent than in adults, resulting in disproportionate respiratory depression.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Multum Information Services, Inc. Expert Review Panel"
Major

Opiate agonists (applies to nalbuphine) gastrointestinal obstruction

Major Potential Hazard, Moderate plausibility.

Opioid agonists are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus.

References

  1. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical (2001):
  2. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  3. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  4. "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc (2018):
View all 4 references
Major

Opiate partial agonists (applies to nalbuphine) acute MI

Major Potential Hazard, Moderate plausibility. Applicable conditions: Ischemic Heart Disease

Opiate partial agonists may increase systemic and pulmonary arterial pressure and systemic vascular resistance, particularly when given by intravenous administration. Data are available for pentazocine and butorphanol. Therapy with opiate partial agonists should be administered cautiously and only if the benefit justifies the risk in patients with acute myocardial infarction (especially if accompanied by hypertension or left ventricular failure) or coronary insufficiency.

References

  1. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  2. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  3. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  4. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  6. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
View all 6 references
Major

Opiate partial agonists (applies to nalbuphine) drug dependence

Major Potential Hazard, High plausibility. Applicable conditions: Drug Abuse/Dependence, Alcoholism

Opiate partial agonists have the potential to cause dependence and abuse, particularly in patients with a history of drug abuse. Tolerance as well as physical and psychological dependence can develop after prolonged use, and abrupt cessation or a significant reduction in dosage may precipitate withdrawal symptoms. Because of their opiate antagonistic effect, withdrawal symptoms may also occur if opiate partial agonists are administered to patients with an opiate dependence or in whom substantial amounts of narcotics have recently been administered. Therapy with opiate partial agonists is not recommended in patients who are physically dependent on narcotics. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with opiate partial agonists. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of opiate therapy should be undertaken gradually using a dosage-tapering schedule.

References

  1. Miser AW, Chayt KJ, Sandlund JT, Cohen PS, Dothage JA, Miser JS "Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates." Am J Dis Child 140 (1986): 603-4
  2. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  3. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  4. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  5. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  6. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  7. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
View all 7 references
Major

Opiate partial agonists (applies to nalbuphine) intracranial pressure

Major Potential Hazard, High plausibility. Applicable conditions: Head Injury, Cerebral Vascular Disorder, Brain/Intracranial Tumor

The hypoventilation associated with administration of opiate partial agonists can induce cerebral hypoxia and vasodilatation with resultant increase in intracranial pressure. Unless mechanical ventilation is provided, extreme caution is advised when opiate partial agonists are given to patients head injury, intracranial lesions, or a preexisting elevated CSF pressure. Also, clinicians treating such patients should be aware that opiate partial agonists may interfere with the evaluation of CNS function, especially with respect to consciousness levels, respiratory status, and pupillary changes.

References

  1. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  2. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  3. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  4. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  5. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  6. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
View all 6 references
Major

Opiate partial agonists (applies to nalbuphine) respiratory depression

Major Potential Hazard, High plausibility. Applicable conditions: Head Injury, Cerebral Vascular Disorder, Brain/Intracranial Tumor, Acute Alcohol Intoxication, Altered Consciousness, Asphyxia, Pulmonary Impairment, Respiratory Arrest

Opiate partial agonists may produce respiratory depression by decreasing respiratory drive and increasing airway resistance. A "ceiling effect" has been noted for these agents, and increasing doses do not produce proportional or further respiratory depression. However, the duration of effect is prolonged. At therapeutic analgesic dosages, the respiratory effects are usually not clinically important except in patients with preexisting pulmonary impairment. Therapy with opiate partial agonists should be avoided or administered with extreme caution and initiated at reduced dosages in patients with severe CNS or respiratory depression; acute alcohol intoxication; sleep apnea; hypoxia, anoxia, or hypercapnia; upper airway obstruction; chronic pulmonary insufficiency; a limited ventilatory reserve; or other respiratory disorders. In the presence of excessive respiratory secretions, the use of opiate partial agonists may also be problematic because they decrease ciliary activity and reduce the cough reflex. Caution is also advised in patients who may be at increased risk for respiratory depression, such as comatose patients or those with head injury, intracranial lesions, or intracranial hypertension. Clinical monitoring of pulmonary function is recommended, and equipment for resuscitation should be immediately available if parenteral routes are used. Naloxone may be administered to reverse clinically significant respiratory depression. However, in the case of buprenorphine, naloxone may not be effective due to buprenorphine's slow rate of dissociation from mu receptors.

References

  1. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  4. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  5. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  6. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  7. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  8. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
View all 8 references
Moderate

Narcotic analgesics (applies to nalbuphine) adrenal insufficiency

Moderate Potential Hazard, Moderate plausibility.

Patients with Addison's disease may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. Conversely, these agents may cause or potentiate adrenal insufficiency. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with adrenocortical insufficiency. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  7. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  12. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  14. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  15. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  16. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  17. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  19. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  20. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  22. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  23. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  24. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  25. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  26. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  27. "Product Information. Olinvyk (oliceridine)." Trevena Inc (2020):
View all 27 references
Moderate

Narcotic analgesics (applies to nalbuphine) biliary spasm

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Biliary Obstruction, Gallbladder Disease

Narcotic (opioid) analgesic agents increase smooth muscle tone in the biliary tract, which can lead to spasm and elevated biliary tract pressure, especially in the sphincter of Oddi. Biliary effects appear to be the most pronounced with morphine, although they do not always occur with therapeutic doses. Therapy with opioids should be administered cautiously in patients with biliary or gallbladder disease.

References

  1. Jones RM, Fiddian-Green R, Knight PR "Narcotic-induced choledochoduodenal sphincter spasm reversed by glucagon." Anesth Analg 59 (1980): 946-7
  2. Hey VM, Ostick DG, Mazumder JK, Lord WD "Pethidine, metoclopramide and the gastro-oesophageal sphincter." Anaesthesia 36 (1981): 173-6
  3. Lang DW, Pilon RN "Naloxone reversal of morphine-induced biliary colic." Anesth Analg 59 (1980): 619-20
  4. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  5. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  6. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  7. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  8. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  9. McCammon RL, Viegas OJ, Stoelting RK, Dryden GE "Naloxone reversal of choledochoduodenal sphincter spasm associated with narcotic administration." Anesthesiology 48 (1978): 437
  10. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  11. Zsigmond EK, Vieira ZEG, Duarte B, Renigers SA, Hirota K "Double-blind placebo-controlled ultrasonographic confirmation of constriction of the common bile duct by morphine." Int J Clin Pharmacol Ther Toxicol 31 (1993): 506-9
  12. Ford MJ, Kellett RJ, Busuttil A, Finlayson ND "Dextropropoxyphene and jaundice." Br Med J 2 (1977): 674
  13. Daikos GK, Kosmidis JC "Propoxyphene jaundice." JAMA 232 (1975): 835
  14. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  15. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  16. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  17. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  18. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  19. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  20. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  21. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  22. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  23. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  24. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  25. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  26. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  27. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  28. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  29. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  30. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  31. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 31 references
Moderate

Narcotic analgesics (applies to nalbuphine) hypothyroidism

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Panhypopituitarism

Patients with hypothyroidism may have increased risk of respiratory depression and prolonged CNS depression associated with the use of narcotic (opioid) analgesic agents. These agents may also exacerbate the effects of hypothyroidism such as lethargy, impaired mentation, depression, and constipation. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with uncontrolled hypothyroidism or myxedema. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  2. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  4. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  5. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  6. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  7. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  10. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  11. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  12. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  13. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  14. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  15. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  16. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  17. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  18. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  19. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  20. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  21. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  22. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  23. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  24. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  25. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
View all 25 references
Moderate

Narcotic analgesics (applies to nalbuphine) renal dysfunction

Moderate Potential Hazard, High plausibility.

Although narcotic (opioid) analgesic agents are generally metabolized by the liver, renal impairment can alter the elimination of these agents and their metabolites (some of which are pharmacologically active), resulting in drug accumulation and increased risk of toxicity. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with significantly impaired renal function. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

References

  1. Findlay JW, Butz RF, Welch RM "Codeine kinetics as determined by radioimmunoassay." Clin Pharmacol Ther 22 (1977): 439-46
  2. Barnes JN, Williams AJ, Tomson MJ, et al. "Dihydrocodeine in renal failure: further evidence for an important role of the kidney in the handling of opioid drugs." Br Med J (Clin Res Ed) 290 (1985): 740-2
  3. Matske GR, Chan GL, Abraham PA "Codeine dosage in renal failure." Clin Pharm 5 (1986): 15-6
  4. Guy DR, Awni WM, Findlay JW, et al. "Pharmacokinetics and pharmacodynamics of codeine in end-stage renal disease." Clin Pharmacol Ther 43 (1988): 63-71
  5. Charuvastra VC, Ouren J "Renal failure and treatment of a methadone maintenance patient." Med J Aust 09/24/77 (1977): 433-4
  6. Verbeeck RK, Branch RA, Wilkinson GR "Drug metabolites in renal failure: pharmacokinetic and clinical implications." Clin Pharmacokinet 6 (1981): 329-45
  7. Drayer DE "Active drug metabolites and renal failure." Am J Med 62 (1977): 486-9
  8. Drayer DE "Pharmacologically active drug metabolites: therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure." Clin Pharmacokinet 1 (1976): 426-43
  9. Parab PV, Ritschel WA, Coyle DE, et al. "Pharmacokinetics of hydromorphone after intravenous, peroral and rectal administration to human subjects." Biopharm Drug Dispos 9 (1988): 187-99
  10. Hill HF, Coda BA, Tanaka A, Schaffer R "Multiple-dose evaluation of intravenous hydromorphone pharmacokinetics in normal human subjects." Anesth Analg 72 (1991): 330-6
  11. Poyhia R, Seppala T, Olkkola KT, Kalso E "The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects." Br J Clin Pharmacol 33 (1992): 617-21
  12. Wolff J, Bigler D, Christensen CB, et al. "Influence of renal function on the elimination of morphine and morphine glucoronides." Eur J Clin Pharmacol 34 (1988): 353-7
  13. Covington EC, Gonsalves-Ebrahim L, Currie KO, et al. "Severe respiratory depression from patient-controlled analgesia in renal failure." Psychosomatics 30 (1989): 226-8
  14. Poyhia R, Olkkola KT, Seppala T, Kalso E "The pharmacokinetics of oxycodone after intravenous injection in adults." Br J Clin Pharmacol 32 (1991): 516-8
  15. Glare PA, Walsh TD "Clinical pharmacokinetics of morphine." Ther Drug Monit 13 (1991): 1-23
  16. Gram LF, Schou J, Way WL, et al. "delta-Propoxyphene kinetics after single oral and intravenous doses in man." Clin Pharmacol Ther 26 (1979): 473-82
  17. Bechtel WD, Sinterhauf K "Plasma level and renal excretion of [3H] codeine phosphate in man and in the dog." Arzneimittelforschung 28 (1978): 308-11
  18. Wolfert AI, Sica DA "Narcotic usage in renal failure." Int J Artif Organs 11 (1988): 411-5
  19. Inturrisi CE "Disposition of narcotics in patients with renal disease." Am J Med 62 (1977): 528-9
  20. Chan K, Jennings F, Orme ML "Pharmacokinetics of low-dose intravenous pethidine in patients with renal dysfunction." J Clin Pharmacol 27 (1987): 516-22
  21. Chauvin M, Sandouk P, Scherrmann JM, Farinotti R, Strumza P, Duvaldestin P "Morphine pharmacokinetics in renal failure." Anesthesiology 66 (1987): 327-31
  22. Aitkenhead AR, Vater M, Achola K, Cooper CM, Smith G "Pharmacokinetics of single-dose i.v. morphine in normal volunteers and patients with end-stage renal failure." Br J Anaesth 56 (1984): 813-9
  23. Sawe J, Odar-Cederlof I "Kinetics of morphine in patients with renal failure." Eur J Clin Pharmacol 32 (1987): 377-82
  24. Baselt RC, Casarett LJ "Urinary excretion of methadone in man." Clin Pharmacol Ther 13 (1972): 64-70
  25. Kreek MJ, Schecter AJ, Gutjahr CL, et al. "Methadone use in patients with chronic renal failure." Drug Alcohol Depend 5 (1980): 197-205
  26. Leow KP, Smith MT, Williams B, Cramond T "Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer." Clin Pharmacol Ther 52 (1992): 487-95
  27. Leow KP, Smith MT, Watt JA, Williams BE, Cramond T "Comparative oxycodone pharmacokinetics in humans after intravenous, oral, and rectal administration." Ther Drug Monit 14 (1992): 479-84
  28. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  29. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  30. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  31. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  32. Dixon R, Crews T, Inturrisi C, Foley K "Levorphanol: pharmacokinetics and steady-state plasma concentrations in patients with pain." Res Commun Chem Pathol Pharmacol 41 (1983): 3-17
  33. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  34. Hanna MH, D'Costa F, Peat SJ, Fung C, Venkat N, Zilkha TR, Davies S "Morphine-6-glucuronide disposition in renal impairment." Br J Anaesth 70 (1993): 511-4
  35. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  36. Gibson TP, Giacomini KM, Briggs WA, Whitman W, Levy G "Propoxyphene and norpropoxyphene plasma concentrations in the anephric patient." Clin Pharmacol Ther 27 (1980): 665-70
  37. Flanagan RJ, Johnston A, White AS, Crome P "Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage." Br J Clin Pharmacol 28 (1989): 463-9
  38. Giacomini KM, Gibson TP, Levy G "Plasma protein binding of d-propoxyphene in normal subjects and anephric patients." J Clin Pharmacol 18 (1978): 106-9
  39. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  40. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  41. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  42. Dhonneur G, Gilton A, Sandouk P, Scherrmann JM, Duvaldestin P "Plasma and cerebrospinal fluid concentrations of morphine and morphine glucuronides after oral morphine - the influence of renal failure." Anesthesiology 81 (1994): 87-93
  43. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  44. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  45. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  46. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  47. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  48. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  49. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  50. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  51. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  52. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  53. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  54. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  55. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  56. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  57. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 57 references
Moderate

Narcotic analgesics (applies to nalbuphine) seizure disorders

Moderate Potential Hazard, Low plausibility. Applicable conditions: Seizures

Narcotic (opioid) analgesic agents may exacerbate seizures in patients with seizure disorders and, at higher dosages, have been reported to induce seizures in patients without previous history of seizures. The proconvulsant activity may be the greatest with meperidine, the active metabolite of which is thought to be responsible. Therapy with opioids should be administered cautiously in patients with or predisposed to seizures.

References

  1. Kaiko RF, Foley KM, Grabinski PY, et al. "Central nervous system excitatory effects of meperidine in cancer patients." Ann Neurol 13 (1983): 180-5
  2. Goetting MG, Thirman MJ "Neurotoxicity of meperidine." Ann Emerg Med 14 (1985): 1007-9
  3. Mauro VF, Bonfiglio MF, Spunt AL "Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia." Clin Pharm 5 (1986): 837-9
  4. Reutens DC, Stewart-Wynne EG "Norpethidine induced myoclonus in a patient with renal failure." J Neurol Neurosurg Psychiatry 52 (1989): 1450-1
  5. Armstrong PJ, Bersten A "Normeperidine toxicity." Anesth Analg 65 (1986): 536-8
  6. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  7. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  8. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  9. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc (2002):
  10. "Product Information. MS Contin (morphine)." Purdue Frederick Company (2002):
  11. Babul N, Darke AC "Putative role of hydromorphone metabolites in myoclonus." Pain 51 (1992): 260-1
  12. Hagmeyer KO, Mauro LS, Mauro VF "Meperidine-related seizures associated with patient-controlled analgesia pumps." Ann Pharmacother 27 (1993): 29-32
  13. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  14. Sebel PS, Bovill JG "Fentanyl and convulsions." Anesth Analg 62 (1983): 858-9
  15. Rao TL, Mummaneni N, El-Etr AA "Convulsions: an unusual response to intravenous fentanyl administration." Anesth Analg 61 (1982): 1020-1
  16. Goroszeniuk T, Albin M, Jones RM "Generalized grand mal seizure after recovery from uncomplicated fentanyl-etomidate anesthesia." Anesth Analg 65 (1986): 979-81
  17. Hoien AO "Another case of grand mal seizure after fentanyl administration." Anesthesiology 60 (1984): 387-8
  18. Safwat AM, Daniel D "Grand mal seizure after fentanyl administration." Anesthesiology 59 (1983): 78
  19. Smith NT, Benthuysen JL, Bickford RG, Sanford TJ, Blasco T, Duke PC, Head N, Dec-Silver H "Seizures during opioid anesthetic induction--are they opioid-induced rigidity?" Anesthesiology 71 (1989): 852-62
  20. Benthuysen JL, Stanley TH "Concerning the possible nature of reported fentanyl seizures." Anesthesiology 62 (1985): 205
  21. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  22. Stone PA, Macintyre PE, Jarvis DA "Norpethidine toxicity and patient controlled analgesia." Br J Anaesth 71 (1993): 738-40
  23. Sjogren P, Dragsted L, Christensen CB "Myoclonic spasms during treatment with high doses of intravenous morphine in renal failure." Acta Anaesthesiol Scand 37 (1993): 780-2
  24. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  25. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  26. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  27. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  28. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  29. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  30. Strong WE, Matson M "Probable seizure after alfentanil." Anesth Analg 68 (1989): 692-3
  31. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  32. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  33. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  34. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  35. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  36. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  37. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  38. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  39. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  40. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  41. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  42. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  43. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  44. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 44 references
Moderate

Narcotic analgesics (applies to nalbuphine) urinary retention

Moderate Potential Hazard, Low plausibility.

Narcotic (opioid) analgesic agents may inhibit the urinary voiding reflex and increase the tone of the vesical sphincter in the bladder. Acute urinary retention requiring catheterization may occur, particularly in patients with prostatic hypertrophy or urethral stricture and in elderly patients. These agents may also decrease urine production via direct effects on the kidney and central stimulation of the release of vasopressin. Therapy with opioids should be administered cautiously in patients with or predisposed to urinary retention and/or oliguria. The effects on smooth muscle tone appear to be the most pronounced with morphine.

References

  1. Kreek MJ, Hartman N "Chronic use of opioids and antipsychotic drugs: side effects, effects on endogenous opioids, and toxicity." Ann N Y Acad Sci 398 (1982): 151-72
  2. Petersen TK, Husted SE, Rybro L, et al. "Urinary retention during I.M. and extradural morphine analgesia." Br J Anaesth 54 (1982): 1175-8
  3. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical (2002):
  4. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals (2002):
  5. "Product Information. Dolophine (methadone)." Lilly, Eli and Company (2002):
  6. "Product Information. Roxanol (morphine)." Roxane Laboratories Inc (2002):
  7. Petros JG, Mallen JK, Howe K, Rimm EB, Robillard RJ "Patient-controlled analgesia and postoperative urinary retention after open appendectomy." Surg Gynecol Obstet 177 (1993): 172-5
  8. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories (2001):
  9. "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company (2001):
  10. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company (2001):
  11. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  12. "Product Information. Sublimaze (fentanyl)." Janssen Pharmaceuticals (2001):
  13. "Product Information. Fentanyl Oralet (fentanyl)." Abbott Pharmaceutical, Abbott Park, IL.
  14. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  15. "Product Information. Alfenta (alfentanil)." Janssen Pharmaceuticals (2001):
  16. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals (2001):
  17. "Product Information. OxyContin (oxycodone)." Purdue Frederick Company (2001):
  18. "Product Information. Ultiva (remifentanil)." Mylan Institutional (formally Bioniche Pharma USA Inc) (2001):
  19. "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals (2001):
  20. "Product Information. Vicoprofen (hydrocodone-ibuprofen)." Knoll Pharmaceutical Company (2001):
  21. "Product Information. Stadol (butorphanol nasal)." Bristol-Myers Squibb (2001):
  22. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC (2001):
  23. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc (2001):
  24. "Product Information. Talwin NX (pentazocine)." Sanofi Winthrop Pharmaceuticals (2001):
  25. "Product Information. Stadol (butorphanol)." Allscrips Pharmaceutical Company (2001):
  26. "Product Information. Dalgan (dezocine)." Astra-Zeneca Pharmaceuticals (2001):
  27. "Product Information. Opium (opium)." Lilly, Eli and Company (2022):
  28. "Product Information. Numorphan (oxymorphone)." Endo Laboratories LLC (2001):
  29. "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc (2001):
  30. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
View all 30 references

Nalbuphine drug interactions

There are 405 drug interactions with nalbuphine.

Nalbuphine alcohol/food interactions

There is 1 alcohol/food interaction with nalbuphine.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.