Background: Endotracheal intubation can elicit significant hemodynamic responses, necessitating effective management to reduce potential complications. This study compared the efficacy of Fentanyl and Nalbuphine in attenuating these responses. Methods: A total of 100 patients undergoing endotracheal intubation were randomized into two groups, receiving either Fentanyl or Nalbuphine. Heart rate, systolic and diastolic blood pressures, mean arterial pressure, rate pressure product, and oxygen saturation were measured at various time points pre- and post-intubation. Results: Nalbuphine significantly reduced heart rate from 3 minutes post-intubation (p<0.05), and was more effective in lowering systolic and diastolic blood pressures (p as low as 0.0001). Mean arterial pressure was better managed with Nalbuphine, particularly noticeable from 3 minutes onward (p<0.05). Rate pressure product was consistently lower in the Nalbuphine group, starting from 1 minute post-intubation (p<0.05). Oxygen saturation levels remained stable and comparable in both groups. Conclusion: Nalbuphine showed superior efficacy in attenuating the hemodynamic responses to endotracheal intubation compared to Fentanyl. Its significant impact on heart rate and blood pressure control, without compromising respiratory function, suggests it as a preferable alternative in clinical anesthesia practice