Intralingual naloxone injection for narcotic-induced respiratory depression

Maio, Ronald F.; Gaukel, Barry; Freeman, Bruce Α.

doi:10.1016/s0196-0644(87)80690-x

Cited by 20 publications

(4 citation statements)

References 10 publications

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“…The sublingual and oral routes for administering naloxone have been found to be less effective than the IM and IV routes because of delayed onset of action 7 . ‐ 8 Pharmacological data from animal studies suggest that naloxone is 100% bioavailable through the nasal mucosa, with onset of action and plasma bioavailability curves that are indistinguishable from those for the IV route 9 .…”

mentioning

confidence: 99%

Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose

Kelly

Kerr

Dietze

et al. 2005

Medical Journal of Australia

141

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Objective: To determine the effectiveness of intranasal (IN) naloxone compared with intramuscular (IM) naloxone for treatment of respiratory depression due to suspected opiate overdose in the prehospital setting. Design: Prospective, randomised, unblinded trial of either 2 mg naloxone injected intramuscularly or 2 mg naloxone delivered intranasally with a mucosal atomiser. Participants and setting: 155 patients (71 IM and 84 IN) requiring treatment for suspected opiate overdose and attended by paramedics of the Metropolitan Ambulance Service (MAS) and Rural Ambulance Victoria (RAV) in Victoria. Main outcome measures: Response time to regain a respiratory rate greater than 10 per minute. Secondary outcome measures were proportion of patients with respiratory rate greater than 10 per minute at 8 minutes and/or a GCS score over 11 at 8 minutes; proportion requiring rescue naloxone; rate of adverse events; proportion of the IN group for whom IN naloxone alone was sufficient treatment. Results: The IM group had more rapid response than the IN group, and were more likely to have more than 10 spontaneous respirations per minute within 8 minutes (82% v 63%; P = 0.0173). There was no statistically significant difference between the IM and IN groups for needing rescue naloxone (13% [IM group] v 26% [IN group]; P = 0.0558). There were no major adverse events. For patients treated with IN naloxone, this was sufficient to reverse opiate toxicity in 74%. Conclusion: IN naloxone is effective in treating opiate‐induced respiratory depression, but is not as effective as IM naloxone. IN delivery of naxolone could reduce the risk of needlestick injury to ambulance officers and, being relatively safe to make more widely available, could increase access to life‐saving treatment in the community.

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mentioning

confidence: 99%

Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose

Kelly

Kerr

Dietze

et al. 2005

Medical Journal of Australia

141

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“…Although generally administered intravenously, anecdotal experience has reported effective reversal of opioid effects with alternative routes of naloxone delivery including intralingual, intramuscular, subcutaneous, rectal, intraosseous, and through an endotracheal tube. [16][17][18][19] Owing to the short half-life of naloxone (30-60 minutes), patients should be monitored for recurrence of toxicity. A continuous infusion can be used to provide an ongoing effect without the need for repeated dosing.…”

Section: Discussionmentioning

confidence: 99%

Adverse Effects Following the Inadvertent Administration of Opioids to Infants and Children

Meyer

Tobias

2005

Clin Pediatr (Phila)

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Regardless of the clinical scenario in which they are administered, opioids can have adverse effects in infants and children. These adverse effects may be particularly problematic when opioids are inadvertently administered since the clinical signs and symptoms may not be readily attributed to opioids without an appropriate history. The authors present 3 clinical scenarios in which adverse effects occurred related to the inadvertent administration of opioids when: (1) acetaminophen with codeine were administered instead of acetaminophen, (2) a mother was breastfeeding while taking opioids, and (3) a fentanyl patch was placed on a superficial injury. A thorough history and physical examination combined with urine/plasma drug screening resulted in the identification of the problem and its effective therapy.

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“…Oltre che per via endovenosa, il naloxone può essere somministrato per altre vie, specie quando si abbia difficoltà nel reperire un accesso venoso adeguato, come in caso di shock [42][43][44] . La via intramuscolare può risultare efficace se non è presente ipoperfusione 43 : essa viene utilizzata anche nella diagnosi di tossicodipendenza [45][46][47] .…”

Section: Impiego Clinico Del Naloxone In Medicina D'urgenzaunclassified

“…ed espongono il personale sanitario a rischio di contatto con fluidi biologici e a trasmissione di malattie 97 . Alternative quali la via sublinguale e la via orale sono meno efficaci rispetto alle IM e IV 98,99 a causa del ritardo nella comparsa dell'effetto e per tale motivo raramente vengono utilizzate in urgenza. Al contrario, i dati di cinetica sull'elevata biodisponibilità del naloxone attraverso la mucosa nasale consentono di paragonare questa via a quella endovenosa sia in studi sperimentali 100 sia nella diagnosi della dipendenza da oppioidi 101 , con tempi di risposta paragonabili a quelli ottenuti per via IV e molto inferiori a quelli per via IM 102 (Figura 3).…”

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Naloxone: intravenously, intramuscular, inhalatory and intranasal use in emergency cases

et al. 2005

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The use of naloxone in emergency medicine is primarily connected to the treatment of a syndrome known as overdose, which is cause by non-essential use of heroin and certain opioid agonists. The dose of naloxone required to be efficacious depends on the quantity of opioid assumed, its receptorial affinity and its kinetics: in propoxyphene and pentazocine intoxication, for instance, higher doses are require than those needed in the treatment of morphine or heroin overdose. Intravenous administration is the most efficacious and fast-acting method: however, in certain cases, and depending on aspects that are typical of overdose patient management (e.g. the difficulties connected to vein access, skin scarring, severe hypotension), alternative pathways may be used. These include intraand sub-lingual and intratracheale administration, inhalatory administration via nebulisation (possible in the presence of respiratory action only), and intramuscular and subcutaneaous administration (which are efficacious in the absence of hypoperfusion). However, the most promising means of administration would appear to be intranasal administration, thanks to the relative ease of access, lower risk of contact with bodily fluids and the excellent bioavailability and rapidity of the effect, which is similar to that achieved with intravenous administration

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Intralingual naloxone injection for narcotic-induced respiratory depression

Cited by 20 publications

References 10 publications

Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose

Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose

Adverse Effects Following the Inadvertent Administration of Opioids to Infants and Children

Naloxone: intravenously, intramuscular, inhalatory and intranasal use in emergency cases

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