General Impaired Respiration: At the usual adult dose of 10 mg/70 kg, NUBAIN causes some respiratory depression approximately equal to that produced by equal doses of morphine. However, in contrast to morphine, respiratory depression is not appreciably increased with higher doses of NUBAIN. Respiratory depression induced by NUBAIN can be reversed by NARCAN® (naloxone hydrochloride) when indicated. NUBAIN should be administered with caution at low doses to patients with impaired respiration (e.g., from other medication, uremia , bronchial asthma, severe infection, cyanosis, or respiratory obstructions). Impaired Renal or Hepatic Function: Because NUBAIN is metabolized in the liver and excreted by the kidneys, NUBAIN should be used with caution in patients with renal or liver dysfunction and administered in reduced amounts. Myocardial Infarction: As with all potent analgesics, NUBAIN should be used with caution in patients with myocardial infarction who have nausea or vomiting. Biliary Tract Surgery: As with all opioid analgesics, NUBAIN should be used with caution in patients about to undergo surgery of the biliary tract since it may cause spasm of the sphincter of Oddi. Cardiovascular System: During evaluation of NUBAIN in anesthesia, a higher incidence of bradycardia has been reported in patients who did not receive atropine pre-operatively.
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