Drug interactions
Hydromorphone + Nalbuphine
Severity: Major
Hydromorphone and Nalbuphine: major interaction.
Last updated
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 mixed agonist-antagonist that can add to sedation in opioid-naive patients. In patients physically dependent on hydromorphone it may block mu receptors and precipitate withdrawal and reduce analgesia.
What this interaction means in plain words
Hydromorphone 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.
Hydromorphone belongs to Musculoskeletal; Nalbuphine belongs to Musculoskeletal.
Why it happens
Partial mu-receptor antagonism by nalbuphine competes with hydromorphone, while kappa agonism adds sedation.
What to do
Avoid giving nalbuphine to patients on regular hydromorphone unless treating opioid-induced adverse effects at low doses. Monitor for withdrawal, loss of analgesia and sedation.
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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Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
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 Hydromorphone with Nalbuphine?
MediHelp rates the interaction as major. Hydromorphone 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 mixed agonist-antagonist that can add to sedation in opioid-naive patients. In patients physically dependent on hydromorphone it may block mu receptors and precipitate withdrawal and reduce analgesia.
How serious is the interaction between Hydromorphone 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 on regular hydromorphone unless treating opioid-induced adverse effects at low doses. Monitor for withdrawal, loss of analgesia and sedation.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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