Use of the mixed agonist-antagonist nalbuphine in opioid based analgesia

摘要

Opiate analgesics provide effective pain relief and are widely used for control of mild to severe pain. The well-known side effects of the mu-agonist opioids, including pruritis, nausea/emesis, constipation, urinary retention, respiratory depression, excessive sedation, and the development of tolerance and dependence, are occasionally problematic. Here we review use of the mixed opioid agonist-antagonist nalbuphine in opioid analgesia with a view to its potential advantages. Used as the sole opioid analgesic, it can satisfactorily cover mild to moderate pain with a low incidence of the common opioid side effects. With care, it can be used concurrently with the more commonly employed mu-opioid agonists (e.g. morphine, hydromorphone, fentanyl), yielding good analgesia while simultaneously decreasing the incidence and severity of mu-agonist side effects. This paper provides information sufficient to enable the practitioner to determine whether nalbuphine might be a useful addition to his/her pharmacopoeia.