Nubain Use In Pregnancy & Lactation

Caution should be exercised when administered to pregnant and nursing patients. Nalbuphine should only be administered when in the judgment of the physician, the potential benefits outweigh the possible hazards.
Use in pregnancy: Safe use of Nubain in pregnancy (other than labor) has not been established. It should only be administered to pregnant women (other than in labor) when, in the judgment of the physician, the potential benefits outweigh the possible hazards. Potent analgesics should be used with caution in women delivering premature infants. In full-term labor, 10-15 mg of nalbuphine has provided analgesia equivalent to that of 75-113 mg of meperidine with fewer maternal side effects.
Use During Labor and Delivery: The placental transfer of nalbuphine is high, rapid and variable with a maternal-to-fetal ratio ranging from 1:0.37 to 1:1.6. Fetal and neonatal adverse effects that have been reported following the administration of nalbuphine to the mother during labor include fetal tachycardia, respiratory depression at birth, apnea and cyanosis. Maternal administration of naloxone during labor has normalized these effects in some cases. Severe and prolonged fetal bradycardia has been reported.
Permanent neurological damage attributed to fetal bradycardia has occurred. A sinusoidal fetal heart rate pattern associated with the use of nalbuphine has also been reported.
Nubain should be used with caution in women during labor and delivery and newborns should be monitored for respiratory depression, apnea, bradycardia and arrhythmias if Nubain has been used.