blood levels of a hormone called Cortisol. In the 1990s nalbuphine was popular among bodybuilders using anabolic steroids. These individuals mainly used nalbuphine to reduce pain caused by exercise regimens. Interviews with such users revealed that many were suffering unwanted physical and mental effects from nalbuphine and that many of these persons were abusing other drugs as well. A case report tells of illicit nalbuphine injection causing muscle damage—the opposite of what bodybuilders seek.

In low amounts nalbuphine can produce morphine effects. High doses tend to make users feel nervous and uncomfortable, however, reducing nalbuphine's attractiveness for illicit recreational use. At those higher dosage levels people can experience vision trouble, sleep disturbance, weird dreams, and thoughts running out of control. The drug is generally considered to have a low potential for abuse, lower than propoxyphene or codeine. Some researchers, however, describe the abuse liability as about equivalent to pentazocine, a drug with a notorious reputation for illicit misuse and that has effects similar to those of nalbuphine. Tolerance and dependence may develop if a person uses nalbuphine in amounts higher than normal medical doses. Withdrawal symptoms are described as those of mild opiate withdrawal.

Drug interactions. Not enough scientific information to report.

Cancer. Standard laboratory tests do not indicate the drug has potential for causing cancer. Long-term experiments with rats and mice have failed to produce cancer.

Pregnancy. Animal research using nalbuphine at high doses has not produced birth defects attributable to the drug. It passes from a pregnant woman into the fetus and can build up there; one study found that newborn levels could be six times higher than maternal levels. Due to effects on the newborn's heartbeat and breathing, controversy exists about the drug's appropriateness for easing pain of childbirth. Some researchers believe the substance is risky during childbirth; some believe nalbuphine is safer than combinations of other drugs. Nalbuphine passes into milk of nursing mothers but is not believed to harm breast-feeding infants.

Additional scientific information may be found in:

Jasinski, D.R., and P.A. Mansky. "Evaluation of Nalbuphine for Abuse Potential." Clinical Pharmacology and Therapeutics 13 (January-February 1972): 78-90. Miller, R.R. "Evaluation of Nalbuphine Hydrochloride." American Journal of Hospital

Pharmacy 37 (1980): 942-49. Saarialho-Kere, U. "Psychomotor, Respiratory and Neuroendocrinological Effects of Nalbuphine and Haloperidol, Alone and in Combination, in Healthy Subjects." British Journal of Clinical Pharmacology 26 (1988): 79-87. Schmidt, W.K., et al. "Nalbuphine." Drug and Alcohol Dependence 14 (1985): 339-62. Stambaugh, J.E. "Evaluation of Nalbuphine: Efficacy and Safety in the Management of Chronic Pain Associated with Advanced Malignancy." Current Therapeutic Research: Clinical and Experimental 31 (1982): 393-401. Wines, J.D., et al. "Nalbuphine Hydrochloride Dependence in Anabolic Steroid Users."

American Journal on Addictions 8 (1999): 161-64. Zacny, J.P., K. Conley, and S. Marks. "Comparing the Subjective, Psychomotor and Physiological Effects of Intravenous Nalbuphine and Morphine in Healthy


Volunteers." Journal of Pharmacology and Experimental Therapeutics 280 (1997): 1159-69.


1. Rakaric-Poznanovic, M., Z. Boljevic, and D. Marcec. "Anestezija Nalbufin/Pro-pofol u Kirurskom Zbrinjavanju Ratnih Ozljeda [Nalbuphine/Propofol Anesthesia in the Surgical Treatment of War Injuries]." Lijecnicki Vjesnik 115 (1993): 303-305. Abstract in English.

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