Naloxone‐associated pulmonary edema in a 3‐year‐old with opioid overdose

Grout, Sarah; Dave, Madhuri; Lefort, Roxanna

doi:10.1002/emp2.12740

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…5,7 Consequently, for acute-on-chronic opioid intoxication, the goal is to use an appropriate amount of naloxone-just enough naloxone to prevent aspiration or apnea-while avoiding an excess that might lead to withdrawal symptoms. 8,9 The maximum permissible dose of naloxone that can be given remains uncertain. Numerous textbooks and articles mention a cumulative limit of 10 mg in total.…”

Section: Discussionmentioning

confidence: 99%

From Friend to Foe: A Case of Naloxone-Induced Pulmonary Edema

Ghalayni,

Al Kalaji,

Malik

2024

Hosp Pharm

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Naloxone, an opioid receptor antagonist, effectively reverses opioid overdose and opioid-induced respiratory depression. A few side effects were reported after naloxone administration, including arrhythmia and pulmonary edema. Although rare, naloxone-induced pulmonary edema can be a severe and sometimes life-threatening complication requiring mechanical ventilation. This condition is predominantly linked to an upsurge in catecholamines after opioid reversal as part of acute withdrawal syndrome, especially seen in patients who chronically use opioids. In this report, we present a case of a 66-year-old patient who developed pulmonary edema following the administration of multiple doses of intravenous and intranasal naloxone for opioid overdose. This case highlights the potential adverse effects associated with naloxone use and discusses how to employ this life-saving medication with minimal side effects.

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Section: Discussionmentioning

confidence: 99%

From Friend to Foe: A Case of Naloxone-Induced Pulmonary Edema

Ghalayni,

Al Kalaji,

Malik

2024

Hosp Pharm

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“…In the world of adult emergency medicine, the side effect of naloxoneinduced noncardiogenic pulmonary edema is a well-known risk that providers fear upon opiate or opioid reversal. However, in the pediatric age group, there have only been a few cases reported, indicating that they may be at lower risk [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Fentanyl in an Infant: Taking Our Breath Away

Ivanov¹,

Weber²,

Javorsky³

2023

Cureus

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Pediatric respiratory failure carries a wide differential diagnosis. Toxic ingestion should remain on the differential even at very young ages. There have been increasing reports of fentanyl overdoses among adults; however, this should be considered for accidental pediatric ingestion, especially considering its high potential for mortality. A nine-month-old female presented to the pediatric emergency department with respiratory failure. The patient was noted to be bradypneic with miotic pupils, and therefore, naloxone was given intravenously (IV) with a positive response. The patient required numerous boluses of intravenous naloxone, which ultimately saved her from intubation. The patient’s laboratory results were later positive for fentanyl and cocaine. Fentanyl ingestion has a high mortality rate, especially in pediatrics. With increasing fentanyl use, there is a potential for exposure due to not only child abuse and intentional toxicity but also exploratory ingestions.

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“…Linking noncardiac pulmonary edema to naloxone in opioid overdose may be dubious [116], since opioid overdose itself may also be associated with the condition. Nevertheless, recent reports have connected naloxone to pulmonary edema [129][130][131]. Moreover, Farkas et al reported that naloxone doses exceeding 4.4 mg increased the risk for pulmonary complications after opioid overdose [132].…”

Section: Adverse Effectsmentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Naloxone

Saari,

Strang,

Dale

2024

Clin Pharmacokinet

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Naloxone is a World Health Organization (WHO)-listed essential medicine and is the first choice for treating the respiratory depression of opioids, also by lay-people witnessing an opioid overdose. Naloxone acts by competitive displacement of opioid agonists at the μ-opioid receptor (MOR). Its effect depends on pharmacological characteristics of the opioid agonist, such as dissociation rate from the MOR receptor and constitution of the victim. Aim of treatment is a balancing act between restoration of respiration (not consciousness) and avoidance of withdrawal, achieved by titration to response after initial doses of 0.4–2 mg. Naloxone is rapidly eliminated [half-life ( t 1/2 ) 60–120 min] due to high clearance. Metabolites are inactive. Major routes for administration are intravenous, intramuscular, and intranasal, the latter primarily for take-home naloxone. Nasal bioavailability is about 50%. Nasal uptake [mean time to maximum concentration ( T max ) 15–30 min] is likely slower than intramuscular, as reversal of respiration lag behind intramuscular naloxone in overdose victims. The intraindividual, interindividual and between-study variability in pharmacokinetics in volunteers are large. Variability in the target population is unknown. The duration of action of 1 mg intravenous (IV) is 2 h, possibly longer by intramuscular and intranasal administration. Initial parenteral doses of 0.4–0.8 mg are usually sufficient to restore breathing after heroin overdose. Fentanyl overdoses likely require higher doses of naloxone. Controlled clinical trials are feasible in opioid overdose but are absent in cohorts with synthetic opioids. Modeling studies provide valuable insight in pharmacotherapy but cannot replace clinical trials. Laypeople should always have access to at least two dose kits for their interim intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-024-01355-6.

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Naloxone‐associated pulmonary edema in a 3‐year‐old with opioid overdose

Cited by 9 publications

References 12 publications

From Friend to Foe: A Case of Naloxone-Induced Pulmonary Edema

From Friend to Foe: A Case of Naloxone-Induced Pulmonary Edema

Fentanyl in an Infant: Taking Our Breath Away

Clinical Pharmacokinetics and Pharmacodynamics of Naloxone

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