Acute Opioid Withdrawal Following Intramuscular Administration of Naloxone 1.6 mg: A Prospective Out-Of-Hospital Series

Opioid Overdose: Limitations in Naloxone Reversal of Respiratory Depression and Prevention of Cardiac Arrest

“…3,[41][42][43][44][45][46] In case of individuals with an opioid use disorder, withdrawal symptoms may become apparent after naloxone administration; symptoms include tachycardia, mild agitation or anxiety, hypertension abdominal pain, malaise, and insomnia. 2,3,41 In extremely rare cases, abrupt reversal of opioid-induced respiratory depression by naloxone has been followed by seizures, pulmonary edema, cardiac dysrhythmias, hypertension, and cardiac arrest. 3,[42][43][44][45] While a direct dose and effect relationship has not been established, the cardiopulmonary complications may be secondary to a sudden release of catecholamines after highdose or rapidly injected naloxone.…”

“…In the event of an opioid overdose, naloxone may have adverse effects, albeit clinical data indicate that serious events are rare. 3,[41][42][43][44][45][46] In case of individuals with an opioid use disorder, withdrawal symptoms may become apparent after naloxone administration; symptoms include tachycardia, mild agitation or anxiety, hypertension abdominal pain, malaise, and insomnia. 2,3,41 In extremely rare cases, abrupt reversal of opioid-induced respiratory depression by naloxone has been followed by seizures, pulmonary edema, cardiac dysrhythmias, hypertension, and cardiac arrest.…”

“…3 In individuals who received naloxone rescue medication in a community setting, agitation and aggression may be dangerous for those providing care such as police, ambulance personnel, and bystanders, and in some cases requires chemical sedation. 41 Finally, it is important to realize that sudden nausea and vomiting may occur upon naloxone administration with a risk of aspiration. 43…”

High-potency benzodiazepine misuse in opioid-dependent patients: use naloxone with care

“…For example, one series of 15 patients with predominantly methadone-induced respiratory depression required a median dose of only 0.08 mg naloxone intravenously to restore adequate ventilation, and two patients receiving this dose developed symptoms of opioid withdrawal 12. In a recent series of 197 patients with predominantly heroin-induced respiratory depression who received a standardised dose of 1.6 mg naloxone intramuscularly, adequate ventilation was restored in 97% of presentations; withdrawal occurred in 39%, severe agitation in 7% and vomiting in 3% 13. The optimal dosing and route of naloxone administration continue to be debated 14…”

Take‐home naloxone and paramedicine: An opportunity for harm minimisation

“…Data from the Queensland Ambulance Service indicate that up to 20% of patients with an opioid overdose refuse transport to hospital. 4 While the risk of re-narcosis (because of the relatively short halflife of naloxone) in these patients remains controversial, it is well established that these patients have an ongoing and persistent risk of opioid overdose into the future. 5 The cohort of patients attended to by paramedics and who refuse transport to hospital represent a unique group of patients, which presents a significant opportunity for ambulance services to play a role in minimising the harms from opioid use.…”