Nalbuphine Ophthalmic

What is nalbuphine ophthalmic?

Nalbuphine ophthalmic is an eye medication used to relieve eye pain. It is classified as an opioid drug.

Nalbuphine ophthalmic is used off-label in dogs, cats, horses, cattle, and rabbits. There are no veterinary formulations available, and the human product (Nubain®) must be compounded or diluted to a 0.8% or 1% nalbuphine solution.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How do I give my pet nalbuphine ophthalmic?

• Nalbuphine ophthalmic comes in a liquid drop format to be instilled directly into the eye (topically).
• Follow your veterinarian’s instructions and give this medication exactly as directed.
• Wash your hands before applying this medication.
• Do not allow anything to touch the dropper tip, including your hands, to avoid contamination.
• Wipe any residue of this medication from the fur of your pet’s face gently with a damp cloth.
• Wait for 5 minutes after applying this medicine before applying any other medicines to the eye.

This medication should take effect within 1–2 hours and improvement in clinical signs should follow.

What if I miss giving my pet the medication?

If you miss a dose of nalbuphine ophthalmic, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects from nalbuphine ophthalmic?

Nalbuphine ophthalmic may cause the following side effects:

• Mild burning, stinging, irritation, or redness of the eyes
• Squinting and tearing of the eyes after application
• Drowsiness or tiredness
• Constipation
• Upset stomach and vomiting

Serious adverse reactions may occur. If any of the following signs develop, stop giving nalbuphine ophthalmic and contact your veterinarian immediately:

• Signs of an allergy to this medication: labored or noisy breathing or swelling of the throat
• Slowed breathing rate

Drug sensitivities can develop over time with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

DO NOT USE nalbuphine ophthalmic in:

• Pets with hypersensitivity or allergy to this medication
• Pets that are receiving other opioids for pain (nalbuphine ophthalmic will reverse the pain-relieving effect of opioids)

USE WITH CAUTION in:

• Pets that must be alert (performance or working animals)
• Pets that have difficulty breathing
• Pets that are prone to constipation or colic (horses and rabbits)
• Pets with corneal ulceration (prolonged use of this medication may impede healing of the cornea and alter tear production)
• Dogs that are not neutered (may cause an anti-analgesic reaction that increases their pain)

Are there any drug interactions I should be aware of?

Certain medications may interact with nalbuphine ophthalmic and so it is important to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

The following medications should be used with caution when given with nalbuphine ophthalmic:

• Opioids (pain-relieving effects may be reversed by nalbuphine ophthalmic)

Is any monitoring needed with this medication?

• At home, monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.
• Your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects.

How do I store nalbuphine ophthalmic?

• Store this product in the refrigerator between 36°F and 46°F (2°C and 8°C) or at controlled room temperature between 68°F and 77°F (20°C and 25°C). Do not freeze.
• Store compounded forms of this medication according to the label.
• Store upright in the original bottle.
• Keep the cap on the bottle tightly closed when not in use.
• Protect from moisture, light and heat.
• Keep the container out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.