Drug interactions
Nalbuphine + Primidone
Severity: Major
Nalbuphine and Primidone: 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
Primidone, metabolised to phenobarbital, adds sedative and respiratory depressant effects to nalbuphine. Profound CNS depression is possible, especially at higher doses.
What this interaction means in plain words
Nalbuphine and Primidone 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 belongs to Musculoskeletal; Primidone belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression from opioid effects and barbiturate (phenobarbital) enhancement of GABA-A activity.
What to do
Use the lowest effective nalbuphine dose and monitor sedation and respiratory rate. Warn the patient against alcohol and driving.
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 Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Other interactions of Primidone
- Lorlatinib + Primidone Contraindicated
- Lurasidone + Primidone Contraindicated
- Primidone + Ranolazine Contraindicated
- Primidone + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
- Primidone + Voriconazole Contraindicated
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Nalbuphine with Primidone?
MediHelp rates the interaction as major. Nalbuphine and Primidone 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. Primidone, metabolised to phenobarbital, adds sedative and respiratory depressant effects to nalbuphine. Profound CNS depression is possible, especially at higher doses.
How serious is the interaction between Nalbuphine and Primidone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective nalbuphine dose and monitor sedation and respiratory rate. Warn the patient against alcohol and driving.
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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