Nalbuphine (Nubain) is a mixed agonist-antagonist that is similar in structure to both the antagonist naloxone and the agonist oxymorphone. It is administered par-enterally and is equipotent to morphine and 5 times as potent as pentazocine. Although the pharmacological effects (analgesia, respiratory depression, sedation, and so on) are similar to those produced by pentazocine, nal-buphine produces fewer psychotomimetic effects. It differs from pentazocine in that it has far greater antagonist than agonist effect. Thus, its use is likely to precipitate severe withdrawal in opioid-dependent patients. It is used much as pentazocine is, that is, for moderate to severe pain, postsurgical anesthesia, and obstetrical analgesia. Nalbuphine's abuse potential is less than that of codeine and propoxyphene, although tolerance and dependence have been shown following chronic administration. High doses are perceived by addicts as being like those of the barbiturates. Drug interactions and contraindications are similar to those for pentazocine and morphine.
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