Recommended Dosage of Nalbuphine for Pain Management
The recommended adult dose of nalbuphine for pain management is 10 mg administered subcutaneously, intramuscularly, or intravenously every 3-6 hours as necessary, with a maximum single dose of 20 mg and maximum total daily dose of 160 mg. 1
Adult Dosing Guidelines
- For moderate to severe pain in adults, the standard dose is 10 mg (for a 70 kg individual) administered subcutaneously, intramuscularly, or intravenously every 3-6 hours as needed 1
- Dosage should be adjusted according to pain severity, patient's physical status, and concomitant medications 1
- The maximum recommended single dose in non-tolerant individuals is 20 mg 1
- The maximum total daily dose should not exceed 160 mg 1
Age-Specific Dosing for Children
- For children less than 3 months of age: 0.05 mg/kg 2
- For children older than 3 months: 0.1 to 0.2 mg/kg, depending on age, titrated to effect 2
- For breakthrough pain in pediatric wards, nalbuphine can be administered every 3-4 hours 2
Special Clinical Situations
As Anesthetic Supplement
- When used as a supplement to balanced anesthesia, higher doses are required: 1
- Induction: 0.3 mg/kg to 3 mg/kg IV administered over 10-15 minutes
- Maintenance: 0.25 to 0.5 mg/kg in single IV administrations as required
For Opioid-Induced Pruritus
- Small doses of nalbuphine (0.5-1 mg IV every 6 hours as needed) can be effective for treating opioid-induced pruritus 2
- For pruritus management, doses of 25-50% of the analgesic dose (2.5-5 mg IV) are typically sufficient and do not attenuate analgesia or increase sedation 3
Gender Considerations
- Women may experience greater analgesic response to nalbuphine than men at equivalent doses 4
- In men, lower doses (5 mg) may paradoxically increase pain (antianalgesic effect), while only the 20 mg dose produces significant analgesia compared to placebo 4
- For women, 10 mg may be the optimal analgesic dose 4
Administration and Monitoring
- Nalbuphine should only be administered by persons trained in the use of intravenous anesthetics and management of respiratory effects of opioids 1
- Naloxone, resuscitative equipment, and oxygen should be readily available 1
- Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases 1
- Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration 1
Discontinuation
- When discontinuing nalbuphine in physically dependent patients, taper the dose gradually by 25-50% every 2-4 days while monitoring for withdrawal symptoms 1
- If withdrawal symptoms develop, increase the dose to the previous level and taper more slowly 1
- Never abruptly discontinue nalbuphine in physically-dependent patients 1
Cautions and Considerations
- Nalbuphine is a mixed agonist-antagonist opioid with a "ceiling effect" for respiratory depression, which may offer safety advantages over pure opioid agonists 5
- At usual analgesic doses, respiratory depression with nalbuphine is comparable to that with morphine 5
- Significant hemodynamic changes are uncommon after usual doses of nalbuphine, even in patients with cardiac disease 5
- For optimal postoperative pain management in laparoscopic procedures, 0.1-0.2 mg/kg may be appropriate for the initial four hours, potentially decreasing to 0.05 mg/kg thereafter 6