Nalbuphine IV Dosing Guidelines
The recommended initial intravenous (IV) dose of nalbuphine for pain management in adults is 10 mg, which may be repeated every 3 to 6 hours as necessary. 1
Adult Dosing
- The standard adult dose is 10 mg IV for a 70 kg individual; dosage should be adjusted according to pain severity, patient status, and concurrent medications 1
- In opioid-naïve individuals, the maximum single dose should not exceed 20 mg with a maximum total daily dose of 160 mg 1
- Dosing frequency is typically every 3-6 hours as needed for pain management 1
- For maintenance doses during balanced anesthesia, 0.25 to 0.5 mg/kg in single IV administrations may be necessary 1
Dose Titration and Individualization
- Titrate nalbuphine to a dose that provides adequate analgesia while minimizing adverse reactions 1
- For opioid-induced pruritus, smaller doses of 0.5-1 mg IV every 6 hours as needed can be effective 2
- Dosage should be adjusted based on:
- Severity of pain
- Patient's physical status
- Concomitant medications, especially CNS depressants 1
Special Populations
Pediatric Dosing
- For children less than 3 months: 0.05 mg/kg IV 2
- For children older than 3 months: 0.1 to 0.2 mg/kg IV 2
Gender Considerations
- Women may experience greater analgesic effects than men at equivalent doses 3
- Men may require higher doses (20 mg) to achieve significant analgesia compared to placebo 3
- Women may achieve optimal analgesia at moderate doses (10 mg) 3
Administration Considerations
- Nalbuphine should be administered only by persons specifically trained in the use of IV anesthetics and management of respiratory effects of potent opioids 1
- Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration 1
- Naloxone, resuscitative equipment, and oxygen should be readily available during administration 1
Monitoring
- Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy 1
- Frequently reassess pain control and adverse effects throughout treatment 1
- For post-operative pain management, medium doses (0.1 mg/kg) to high doses (0.2 mg/kg) may provide better initial pain control than low doses (0.05 mg/kg) 4
Pharmacokinetic Considerations
- Peak plasma concentrations occur approximately 30-40 minutes after administration 5
- Mean elimination half-life is approximately 2.2-2.6 hours 5
Cautions and Contraindications
- Use with caution when combining with other sedative agents, particularly benzodiazepines, due to increased risk of respiratory depression 6
- When discontinuing treatment in physically dependent patients, taper the dose gradually by 25% to 50% every 2 to 4 days to prevent withdrawal symptoms 1
- Never abruptly discontinue nalbuphine in physically dependent patients 1