Nalbuphine Injection

Nalbuphine injection may be habit forming. Use nalbuphine injection exactly as directed. Do not use more or less of it, stop using it suddenly, use it more often, or use it for a longer period of time or in a different way than prescribed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or has had an overdose, or if you have or have ever had depression or another mental illness.

Nalbuphine injection may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.

Taking certain other medications, drinking alcohol, or using street drugs during your treatment with nalbuphine injection may increase the risk of serious or life-threatening breathing problems, sedation, or coma. Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the dosages of your medications and will monitor you carefully.

Nalbuphine injection may harm or cause death to other people who take your medication, especially children. Keep nalbuphine injection in a safe place so that no one else can take it accidentally or on purpose.

Tell your doctor if you are pregnant or plan to become pregnant. If you use nalbuphine injection regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth.

Talk to your doctor about the risk(s) of using nalbuphine injection.

Nalbuphine injection is used to relieve severe pain. It is also used with other medications and anesthesic agents before, during, and after surgery and other medical procedures. Nalbuphine injection is in a class of medications called opioid agonist-antagonists. It works by changing the way the body senses pain.

Nalbuphine injection comes as a solution (liquid) to inject subcutaneously (under the skin), intravenously (into a vein), or intramuscularly (into a muscle). Inject once every 3 to 6 hours as needed.

Your doctor may adjust your dose of nalbuphine injection during your treatment, depending on how well your pain is controlled and on the side effects that you experience. Talk to your doctor about how you are feeling during your treatment with nalbuphine injection. Tell your doctor if you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain during your treatment with nalbuphine injection.

Talk to your doctor or pharmacist about access to rescue medicines, naloxone or nalmefene, while taking nalbuphine injection. Rescue medications can reverse the life-threatening effects of an opioid overdose and are available over the counter or with a prescription. Make sure that you and your family members and people usually around you know how to recognize an overdose, how to use naloxone or nalmefene, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and others how to use it. If symptoms of an overdose occur, they should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. If your symptoms return, the person should give you another dose of the rescue medication. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Do not stop using nalbuphine injection suddenly. If you suddenly stop using nalbuphine injection, you may experience withdrawal symptoms including restlessness; teary eyes; runny nose; yawning; sweating; chills; muscle, back or joint pain; widening of the pupils; irritability; anxiety; weakness; stomach cramps; difficulty falling asleep or staying asleep; nausea; loss of appetite; vomiting; diarrhea; fast breathing; or fast heartbeat. Your doctor will probably decrease your dose gradually.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before receiving nalbuphine injection,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• some medications should not be taken with nalbuphine. Make sure you have discussed any medications you are currently taking or plan to take before starting nalbuphine with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking nalbuphine, please get the advice of your doctor or pharmacist.
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, or tranylcypromine.
• the following nonprescription or herbal products may interact with nalbuphine: St. John's wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using nalbuphine. Do not start these medications while using nalbuphine without discussing it with your healthcare provider.
• tell your doctor if you have slowed breathing, asthma, chronic pulmonary disease (COPD), or other lung problems or have ever had a blockage in your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to receive nalbuphine injection.
• tell your doctor if you have or have ever had a brain tumor, or any condition that increases the amount of pressure in your brain; seizures; or liver, pancreas, gallbladder, heart, or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking nalbuphine, call your doctor.
• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using nalbuphine injection.
• you should know that nalbuphine may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know to not drink alcoholic beverages while you are using nalbuphine injection. Alcohol can make the side effects from nalbuphine worse.
• you should know that nalbuphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• you should know that nalbuphine may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are using nalbuphine injection.

Unless your doctor tells you otherwise, continue your normal diet.

Nalbuphine injection may cause side effects. Tell your doctor if any of these symptoms or those in the SPECIAL PRECAUTIONS section are severe or do not go away:

• nausea, vomiting
• dry mouth
• headache
• decreased sexual desire, inability to get or keep an erection

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• extreme tiredness
• seizures
• nausea, vomiting, loss of appetite, weakness, or dizziness
• chest pain, changes in heartbeat
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
• rash; hives; itching; hoarseness; difficulty breathing or swallowing; or swelling of the face, mouth, tongue or throat
• new pain or pain from touch or doing ordinary tasks such as combing your hair
• difficulty swallowing, regurgitation (bringing up swallowed food into throat and mouth), pain in the chest area
• unusual snoring or long pauses during breaths during sleep

Nalbuphine injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, out of reach of children, and in a location that is not easily accessible by others, including visitors to the home. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Dispose of any medication that is outdated or no longer needed through a medicine take-back program. If you do not have a take-back program nearby or one that you can access promptly, flush any nalbuphine injection solution that is outdated or no longer needed down the toilet. Talk to your pharmacist about the proper disposal of your medication.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• slow, shallow, or irregular breathing
• excessive sleepiness, unable to respond or wake up
• cold, clammy skin
• limp muscles
• narrowed or widened pupils (dark circles in the middle of the eyes)
• slow heartbeat

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are using nalbuphine injection.

This prescription is not refillable. If you continue to have pain after you finish nalbuphine injection, call your doctor.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

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