Drug interactions
Diamorphine + Nalbuphine
Severity: Major
Diamorphine and Nalbuphine: major interaction.
Last updated Sources: Health Canada product monograph
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Nalbuphine is a kappa agonist and mu antagonist that can partially block the effect of full mu agonists such as diamorphine. In patients physically dependent on opioids it may precipitate withdrawal, and in others it adds to sedation and respiratory depression.
What this interaction means in plain words
Diamorphine and Nalbuphine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Competitive mu-receptor antagonism or partial antagonism by nalbuphine, plus additive opioid CNS and respiratory depression.
What to do
Avoid giving nalbuphine to patients dependent on or recently given diamorphine unless withdrawal is specifically anticipated and managed. If used, monitor for withdrawal, loss of analgesia and respiratory depression.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Frequently asked questions
Can I take Diamorphine with Nalbuphine?
MediHelp rates the interaction as major. Diamorphine and Nalbuphine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Nalbuphine is a kappa agonist and mu antagonist that can partially block the effect of full mu agonists such as diamorphine. In patients physically dependent on opioids it may precipitate withdrawal, and in others it adds to sedation and respiratory depression.
How serious is the interaction between Diamorphine and Nalbuphine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid giving nalbuphine to patients dependent on or recently given diamorphine unless withdrawal is specifically anticipated and managed. If used, monitor for withdrawal, loss of analgesia and respiratory depression.
What other medicines interact with Nalbuphine?
MediHelp also lists interactions of Nalbuphine with, for example, Alvimopan, Olanzapine / samidorphan, Alprazolam. The full list is on the Nalbuphine page.
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