Nalbuphine HCL is currently available only as an injectable in the US and the European Union. Nubain, the Astra USA brand name for injectable nalbuphine HCL, was discontinued from being marketed in 2008 in the United States for commercial reasons (Federal Register 2008); however, other commercial suppliers now provide generic injection formulation nalbuphine for the market. Society and culture
Brand names
Nalbuphine is marketed primarily under the brand names Nubain, Nalpain, and Nalbuphin. It is also marketed under the brand name Nalufin in Egypt and Raltrox in Bangladesh by Opsonin Pharma Limited, under the brand name Rubuphine in India by Rusan Healthcare Pvt Ltd, under the brand name Kinz and Nalbin in Pakistan by Sami and Global Pharmaceuticals, under the brand name Analin by Medicaids in Pakistan, and under the brand name Exnal by Indus Pharma in Pakistan, among many others. Legal status
Unlike many other opioids, nalbuphine has a limited potential for euphoria, and in accordance, is rarely abused. This is because whereas MOR agonists produce euphoria, MOR antagonists do not, and KOR agonists like nalbuphine moreover actually produce dysphoria. Nalbuphine was initially designated as a Schedule II controlled substance in the United States along with other opioids upon the introduction of the 1970 Controlled Substances Act. However, its manufacturer, Endo Laboratories, Inc., petitioned the Food and Drug Administration to remove it from Schedule II in 1973, and after a medical and scientific review, nalbuphine was removed completely from the Controlled Substances Act in 1976 and is not a controlled substance in the United States today.
Obstetric: Pseudo-sinusoidal fetal heart rhythm.Other possible, but rare side effects include speech difficulty, urinary urgency, blurred vision, flushing and warmth. A 2014 Cochrane Systematic Review by Schnabel et al., concluded that due to limited data, analysis of adverse events for children treated with nalbuphine compared to other opioids or placebo for postoperative pain, could not be definitively reported. Overdose
In case of overdose or adverse reaction, the immediate intravenous administration of naloxone (Narcan) is a specific antidote. Oxygen, intravenous fluids, vasopressors and other supportive measures should be used as indicated. Pharmacology
Pharmacodynamics
Nalbuphine is a semisynthetic mixed agonist/antagonist opioid modulator of the phenanthrene or morphinan series. It is structurally related to the widely used opioid antagonists naloxone and naltrexone, and to the potent opioid analgesic oxymorphone. Nalbuphine binds with high affinity to the MOR and KOR, and has relatively low affinity for the DOR. It behaves as a moderate-efficacy partial agonist (or mixed agonist/antagonist) of the MOR and as a high-efficacy partial agonist of the KOR. Nalbuphine has weak or no affinity for the sigma receptor(s) (e.g., Ki > 100,000 nM).Nalbuphine is said to be more morphine-like at lower doses. However at higher doses, it produces more sedation, drunkenness, dysphoria, and dissociation. As such, its effects are dose-dependent. Such effects include sedation (21–36%), dizziness or vertigo (5%), lightheadedness (1%), anxiety (<1%), dysphoria (<1%), euphoria (<1%), confusion (<1%), hallucinations (<1%), depersonalization (1%), unusual dreams (<1%), and feelings of "unreality" (<1%).Nalbuphine is a potent analgesic.