Nalbuphine Dosage for Adults
The standard adult dose of nalbuphine is 10 mg for a 70 kg individual, administered subcutaneously, intramuscularly, or intravenously, repeated every 3-6 hours as needed, with a single maximum dose of 20 mg and maximum daily dose of 160 mg in opioid-naïve patients. 1
Standard Analgesic Dosing
- Initial dose: 10 mg (for 70 kg adult) via subcutaneous, intramuscular, or intravenous routes 1
- Dosing interval: Every 3-6 hours as necessary 1
- Single maximum dose: 20 mg in opioid-naïve individuals 1
- Maximum daily dose: 160 mg total 1
Route-Specific Considerations
- All three parenteral routes (IV, IM, SC) demonstrate similar bioavailability (76-83%) and are clinically interchangeable 2
- Peak plasma concentrations occur 30-40 minutes after IM or SC administration 2
- Elimination half-life ranges 2.2-2.6 hours regardless of route or dose 2
Specialized Clinical Applications
For Opioid-Induced Pruritus
Use 0.5-1 mg IV every 6 hours as needed when managing opioid-induced pruritus that persists despite antihistamine therapy 3, 4. This represents 25-50% of the standard analgesic dose and effectively treats pruritus without attenuating analgesia 5.
As Anesthetic Supplement
- Induction doses: 0.3-3 mg/kg IV over 10-15 minutes 1
- Maintenance doses: 0.25-0.5 mg/kg as single IV administrations as required 1, 4
Age-Related Dosing Adjustments
Elderly Patients (≥65 years)
- Reduce initial doses and extend dosing intervals due to decreased systemic clearance and increased bioavailability (46% vs 12% in younger adults) 6
- Elimination half-life increases to 2.3 hours in elderly versus 1.9 hours in younger adults 6
- More frequent clinical observation and dose adjustment required 7
Pediatric Patients
- Age <3 months: 0.05 mg/kg 4
- Age >3 months: 0.1-0.2 mg/kg, titrated to effect 4
- Breakthrough pain: Administer every 3-4 hours 4
- Note: Elimination half-life is significantly shorter in children (0.9 hours), requiring more frequent dosing 6
Critical Safety Considerations
Dose Titration Principles
- Start with lowest effective dose and titrate based on pain severity, physical status, and concurrent medications 1
- Monitor for respiratory depression, especially within first 24-72 hours of initiation 1
- Assess efficacy and side effects every 60 minutes for oral/IM/SC routes and every 15 minutes for IV administration 7
Concomitant CNS Depressants
Exercise extreme caution when combining nalbuphine with benzodiazepines or other sedating agents due to increased respiratory depression risk 4. This combination requires enhanced monitoring and potentially lower nalbuphine doses.
Use in Opioid-Tolerant Patients
Caution is advised when using nalbuphine in opioid-tolerant patients as its mixed agonist-antagonist properties may reduce analgesic effects or precipitate withdrawal symptoms 7. The National Comprehensive Cancer Network specifically warns against this combination in chronically opioid-dependent patients 7.
Discontinuation Protocol
Taper gradually by 25-50% every 2-4 days in physically dependent patients to avoid withdrawal symptoms 1. If withdrawal signs develop, increase dose back to previous level and taper more slowly by either extending intervals between decreases or reducing the magnitude of dose changes 1.