Nalbuphine (Nubain) is structurally a member of the phenanthrene class of compounds and resembles oxymor-phone with a cyclobutyl methyl group on the nitrogen, equivalent to naloxone's substitution. It was introduced in 1979 as an agonist/antagonist with the hope of becoming an effective pain reliever with little abuse potential. Although the abuse potential of nalbuphine is low, it is not zero, and increasing reports of diversion and abuse can be found in the literature and the Internet.105 At low parenteral doses (<0.5 mg), it has an analgesic potency approximately two thirds that of morphine, and it has a similar degree of respiratory depression. However, escalating doses above 30 mg does not produce further respiratory depression.106 The oral bioavailability of nalbuphine is only 12%, and the drug is only marketed as an injectable.107 Patents have been filed for an oral extended-release formulation, and it is presently in phase II testing.108 The pharmacologic profile of nalbuphine in animal studies includes agonist activity at the K-receptor and antagonist activity at the /-receptor.109 Clinical studies have shown that nalbuphine, and K-agonists in general, may have better analgesic activity in female patients compared with male patients.77 Used as the sole opioid agent, nal-buphine has been used successfully to treat the pain of labor, cesarean section, dental extraction, hip replacement, and hysterectomy surgery.110 Nalbuphine also may have a role in treating opioid-induced pruritus, because it can reverse the pruritus without reversing the analgesic effect when used in low doses. Nalbuphine is marketed as an injectable (10 and 20 mg/mL). The usual dose is 10 mg administered subcuta-neously, intramuscularly, or intravenously at 3- to 6-hour intervals, with a maximal daily dose of 160 mg.
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A Guide to Natural Sleep Remedies. Many of us experience the occasional night of sleeplessness without any consequences. It is when the occasional night here and there becomes a pattern of several nights in arow that you are faced with a sleeping problem. Repeated loss of sleep affects all areas of your life The physical, the mental, and theemotional. Sleep deprivation can affect your overall daily performance and may even havean effecton your personality.