Opioid-Induced Pruritus: A Case Series on Novel Uses of Nalbuphine in the Emergency Department

Opioid-induced pruritus is a frequent and distressing adverse effect of mu-opioid receptor agonists, often unresponsive to antihistamines such as diphenhydramine. Nalbuphine, a mixed kappa-opioid receptor agonist and mu-opioid receptor antagonist, offers both analgesia and pruritus prevention via targeted receptor mechanisms. We present 2 cases highlighting nalbuphine's utility in the emergency department: one demonstrating prophylactic low-dose nalbuphine (2.5 mg IV) coadministered with hydromorphone in a pruritus-prone patient and one where nalbuphine (10 mg IV) served as a primary analgesic. In both cases, patients achieved pain relief without experiencing pruritus or sedation. These cases underscore nalbuphine's potential as a safe and evidence-informed alternative in acute care settings.