What the FDA labels say about taking them together
Hydromorphone and nalbuphine
Hydromorphone's FDA label of May 14, 2026 names nalbuphine in its drug interactions section; nalbuphine's label does not name hydromorphone itself but warns about its class (Opioids (opioid agonists)). The hydromorphone label: “May reduce the analgesic effect of Hydromorphone Hydrochloride Injection and/or precipitate withdrawal symptoms.”
Check it at the source: the hydromorphone FDA label on DailyMed (effective May 14, 2026, Rhodes Pharmaceuticals LLC); the nalbuphine FDA label on DailyMed (effective December 31, 2025, Hospira, Inc.).
What does the hydromorphone label say about nalbuphine?
Hydromorphone label, drug interactionsMixed Agonist/Antagonist and Partial Agonist Opioid Analgesics Clinical Impact: May reduce the analgesic effect of hydromorphone hydrochloride oral solution or hydromorphone hydrochloride tablets and/or precipitate withdrawal symptoms. Intervention: Avoid concomitant use. Examples: Butorphanol, nalbuphine, pentazocine, and buprenorphine.
Hydromorphone label, warnings and precautionsAdditionally, avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including hydromorphone hydrochloride oral solution or hydromorphone hydrochloride tablets.
Source: FDA drug label (Hydromorphone Hydrochloride, NDA019034), Fresenius Kabi USA, LLC, effective July 15, 2026 (SPL set e034eb96-03e0-46e1-8b92-5e1f94555e7b), via openFDA
Source: FDA drug label (Hydromorphone Hydrochloride), Rhodes Pharmaceuticals LLC, effective May 14, 2026 (SPL set 37565441-0d95-4743-a695-d7b3326f58a1), via openFDA; the full label on DailyMed
What does the nalbuphine label say about hydromorphone?
Nalbuphine's label does not name hydromorphone itself; it warns about its class (Opioids (opioid agonists)):
Nalbuphine label, warningsLife-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended.
Nalbuphine label, boxed warningSERIOUS AND LIFE-THREATENING RISKS FROM USE OF NALBUPHINE HYDROCHLORIDE INJECTION Addiction, Abuse, and Misuse Because the use of Nalbuphine Hydrochloride Injection exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death, assess each patient's risk prior to prescribing and reassess all patients regularly for the development of these behaviors and conditions [see WARNINGS ].
Source: FDA drug label (Nalbuphine Hydrochloride), Hospira, Inc., effective December 31, 2025 (SPL set 6025e8d4-5083-4c3a-58a0-050e7b0b6150), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Hydromorphone | Nalbuphine | |
|---|---|---|
| Labeled for | Pain | Pain |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $0.219 per tablet 4 mg tablet | $4.32 per mL 10 mg/mL ampul |
| Shortage now | In shortage | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once