Naloxone dosage for opioid reversal: current evidence and clinical implications - PubMed (original) (raw)
Review
Naloxone dosage for opioid reversal: current evidence and clinical implications
Rachael Rzasa Lynn et al. Ther Adv Drug Saf. 2018 Jan.
Abstract
Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduction in mortality following an opioid overdose. Reversal of opioid toxicity may precipitate an opioid-withdrawal syndrome. At the same time, there is a risk of inadequate response or re-narcotization after the administration of a single dose of naloxone in patients who have taken large doses or long-acting opioid formulations, as the duration of effect of naloxone is shorter than that of many opioid agonists. As out-of-hospital use of this medication is growing, so too is concern about effective but safe dosing.
Keywords: harm reduction; naloxone; opioid overdose; route of administrations.
Conflict of interest statement
Conflict of interest statement: The authors declare that there is no conflict of interest.
Similar articles
- Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel [Internet].
Chou R, Korthuis PT, McCarty D, Coffin P, Griffin J, Davis-O’Reilly C, Grusing S, Daya M. Chou R, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Nov. Report No.: 17(18)-EHC025-EF. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Nov. Report No.: 17(18)-EHC025-EF. PMID: 29528608 Free Books & Documents. Review. - Emergency medical services naloxone access: a national systematic legal review.
Davis CS, Southwell JK, Niehaus VR, Walley AY, Dailey MW. Davis CS, et al. Acad Emerg Med. 2014 Oct;21(10):1173-7. doi: 10.1111/acem.12485. Acad Emerg Med. 2014. PMID: 25308142 Review. - Prepacked naloxone administration for suspected opioid overdose in the era of illicitly manufactured fentanyl: a retrospective study of regional poison center data.
Mahonski SG, Leonard JB, Gatz JD, Seung H, Haas EE, Kim HK. Mahonski SG, et al. Clin Toxicol (Phila). 2020 Feb;58(2):117-123. doi: 10.1080/15563650.2019.1615622. Epub 2019 May 16. Clin Toxicol (Phila). 2020. PMID: 31092050 - Intranasal and Intramuscular Naloxone for Opioid Overdose in the Pre-Hospital Setting: A Review of Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet].
Peprah K, Severn M. Peprah K, et al. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Nov 26. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Nov 26. PMID: 32181999 Free Books & Documents. Review. - Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine.
Strang J, McDonald R, Campbell G, Degenhardt L, Nielsen S, Ritter A, Dale O. Strang J, et al. Drugs. 2019 Sep;79(13):1395-1418. doi: 10.1007/s40265-019-01154-5. Drugs. 2019. PMID: 31352603 Free PMC article. Review.
Cited by
- New and Emerging Opioid Overdose Risk Factors.
Foglia R, Kline A, Cooperman NA. Foglia R, et al. Curr Addict Rep. 2021;8(2):319-329. doi: 10.1007/s40429-021-00368-6. Epub 2021 Apr 22. Curr Addict Rep. 2021. PMID: 33907663 Free PMC article. Review. - Naloxone-Induced Acute Pulmonary Edema is Dose-Dependent: A Case Series.
Al-Azzawi M, Alshami A, Douedi S, Al-Taei M, Alsaoudi G, Costanzo E. Al-Azzawi M, et al. Am J Case Rep. 2021 Mar 17;22:e929412. doi: 10.12659/AJCR.929412. Am J Case Rep. 2021. PMID: 33730013 Free PMC article. - Novel Vaccine That Blunts Fentanyl Effects and Sequesters Ultrapotent Fentanyl Analogues.
Barrientos RC, Bow EW, Whalen C, Torres OB, Sulima A, Beck Z, Jacobson AE, Rice KC, Matyas GR. Barrientos RC, et al. Mol Pharm. 2020 Sep 8;17(9):3447-3460. doi: 10.1021/acs.molpharmaceut.0c00497. Epub 2020 Aug 13. Mol Pharm. 2020. PMID: 32787282 Free PMC article. - Long-term antagonism and allosteric regulation of mu opioid receptors by the novel ligand, methocinnamox.
Zamora JC, Smith HR, Jennings EM, Chavera TS, Kotipalli V, Jay A, Husbands SM, Disney A, Berg KA, Clarke WP. Zamora JC, et al. Pharmacol Res Perspect. 2021 Dec;9(6):e00887. doi: 10.1002/prp2.887. Pharmacol Res Perspect. 2021. PMID: 34713624 Free PMC article. - Covalently Loaded Naloxone Nanoparticles as a Long-Acting Medical Countermeasure to Opioid Poisoning.
Kassick AJ, Wu M, Luengas D, Ebqa'ai M, Tharika Nirmani LP, Tomycz N, Nelson TL, Pravetoni M, Raleigh MD, Averick S. Kassick AJ, et al. ACS Pharmacol Transl Sci. 2021 Aug 26;4(5):1654-1664. doi: 10.1021/acsptsci.1c00168. eCollection 2021 Oct 8. ACS Pharmacol Transl Sci. 2021. PMID: 34661081 Free PMC article.
References
- Centers for Disease Control and Prevention. Injury prevention and control: opioid overdose, www.cdc.gov/drugoverdose/data/statedeaths.html (2016, accessed 1 October 2017).
- Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014; 8: 153–163. - PubMed
- Jasinski DR, Martin WR, Haertzen CA. The human pharmacology and abuse potential of N-allylnoroxymorphone (naloxone). J Pharmacol Exp Ther 1967; 157: 420–426. - PubMed
Publication types
LinkOut - more resources
Full Text Sources
Other Literature Sources
Research Materials