Last update Aug. 16, 2022



Safe substance and/or breastfeeding is the best option.

A strong opioid analgesic equivalent to morphine with a partially antagonistic action. It is used during childbirth and cesarean section. Administered subcutaneously, intramuscularly or intravenously every 3 to 6 hours.

It is excreted in breastmilk in clinically insignificant amounts. (Reece 2017, Mustafa 2016, FDA 2016, Jacqz-Aigrain 2007, Wischnik 1988)

Its low oral bioavailability (Aitkenhead 1988) hinders transfer to the infant’s plasma from ingested breastmilk.

The time of onset of breastfeeding was delayed in newborns whose mothers received analgesia at delivery with butorphanol or nalbuphine compared to those who did not receive analgesia, although in both groups it occurred on average within the first hour after birth. (Crowell 1994)

There is a dosage and it is considered safe in the pediatric age group without causing respiratory depression. (Kubica 2015)

Unlike other opioids, its metabolites are inactive. (Martin 2018)

It can increase the secretion of prolactin. (Saarialho 1988)

Not available in several countries including Spain.


  • Ibuprofen (Safe substance and/or breastfeeding is the best option.)
  • Paracetamol (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.


N02AF02 belongs to this group or family:


Main tradenames from several countries containing N02AF02 in its composition:


Variable Value Unit
Oral Bioavail. 11.8 (6 – 20) %
Molecular weight 394 daltons
VD 6.7 l/Kg
pKa 10.39 -
Tmax 0.01 - 0.25 hours
2.4 - 5 hours
M/P ratio 1.2 -
Theoretical Dose 0.007 – 0.009 mg/Kg/d
Relative Dose 0.59 ± 0.27 %


  1. Martin E, Vickers B, Landau R, Reece-Stremtan S. ABM Clinical Protocol #28, Peripartum Analgesia and Anesthesia for the Breastfeeding Mother. Breastfeed Med. 2018 Abstract Full text (link to original source) Full text (in our servers)
  2. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  3. FDA. Nalbuphine. Drug Summary. 2016 Full text (in our servers)
  4. Moustafa AA, Baaror AS, Abdelazim IA. Comparative study between nalbuphine and ondansetron in prevention of intrathecal morphine-induced pruritus in women undergoing cesarean section. Anesth Essays Res. 2016 Abstract Full text (link to original source) Full text (in our servers)
  5. Kubica-Cielińska A, Zielińska M. The use of nalbuphine in paediatric anaesthesia. Anaesthesiol Intensive Ther. 2015 Abstract Full text (link to original source) Full text (in our servers)
  6. Jacqz-Aigrain E, Serreau R, Boissinot C, Popon M, Sobel A, Michel J, Sibony O. Excretion of ketoprofen and nalbuphine in human milk during treatment of maternal pain after delivery. Ther Drug Monit. 2007 Abstract
  7. Nice FJ, De Eugenio D, Dimino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and Other Healthcare Professionals. Part I. J Pharm Technol 2004;20:17-27. doi: 10.1177/875512250402000106.
  8. Crowell MK, Hill PD, Humenick SS. Relationship between obstetric analgesia and time of effective breast feeding. J Nurse Midwifery. 1994 May-Jun;39(3):150-6. Abstract
  9. Wischnik A, Wetzelsberger N, Lücker PW. [Elimination of nalbuphine in human milk]. Arzneimittelforschung. 1988 Abstract
  10. Saarialho-Kere U. Psychomotor, respiratory and neuroendocrinological effects of nalbuphine and haloperidol, alone and in combination, in healthy subjects. Br J Clin Pharmacol. 1988 Abstract Full text (link to original source) Full text (in our servers)
  11. Aitkenhead AR, Lin ES, Achola KJ. The pharmacokinetics of oral and intravenous nalbuphine in healthy volunteers. Br J Clin Pharmacol. 1988 Abstract Full text (link to original source) Full text (in our servers)

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