Nasal Administration of Naloxone Is as Effective as the Intravenous Route in Opiate Addicts

Loimer, Norbert; Hofmann, Peter; Chaudhry, Haroon Rashid

doi:10.3109/10826089409047912

Cited by 55 publications

(48 citation statements)

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“…Preclinical data from rodent studies showed complete absorption of nasal naloxone (bioavailability relative to IV: F% = 101%; Hussain et al, 1984). In first in-human trials, nasal naloxone was found to elicit withdrawal symptoms in opioid-dependent volunteers (Loimer et al, 1992(Loimer et al, , 1994. Since the early 2000s, nasal naloxone has been used off-label by ambulance personnel (Barton et al, 2005(Barton et al, , 2002Belz et al, 2006;Kelly et al, 2005;Kerr et al, 2009;Merlin et al, 2010;Robertson et al, 2009;Weber et al, 2012) and in the emergency department (Sabzghabaee et al, 2014).…”

Section: Sublingualmentioning

confidence: 99%

Naloxone without the needle − systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal

Strang

McDonald

Alqurshi

et al. 2016

Drug and Alcohol Dependence

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. (2016). Naloxone without the needle systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal. Drug and Alcohol Dependence. DOI: 10.1016DOI: 10. /j.drugalcdep.2016 Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rightsCopyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.•You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to the work immediately and investigate your claim. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. After 40 years of injection-based naloxone treatment, non-injectable routes are finally being developed. Nasal naloxone has recently been approved and will soon be fieldtested, buccal naloxone holds promise, and it is unclear what sublingual naloxone will contribute. Development and approval of reliable non-injectable formulations will facilitate wider naloxone provision across the community internationally.

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Section: Sublingualmentioning

confidence: 99%

Naloxone without the needle − systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal

Strang

McDonald

Alqurshi

et al. 2016

Drug and Alcohol Dependence

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“…After dual review of abstracts and titles, 202 articles were selected for full-text dual review, and 13 studies were determined to meet inclusion criteria and were included in this review. We identified three RCTs (n=100 to 182) [37][38][39] and four cohort studies (n=93 to 609) [40][41][42][43] that compared different routes of naloxone administration.…”

Section: Results Of Literature Searchesmentioning

confidence: 99%

“…Observational studies were of very limited usefulness for informing route of administration comparisons, due to serious methodological shortcomings, including failure to adjust for potential confounders. [40][41][42][43] In addition, the route of administration comparisons varied across the studies.Evidence was insufficient to determine how comparative benefits and harms of different routes of naloxone administration differed according to demographics or clinical factors, such as the type and dose of opioid involved in overdose (including whether fentanyl or a fentanyl analogue was involved), presence of other drugs or substances, estimated time since overdose, concomitant psychiatric comorbidities, or prior overdose episodes. There was also insufficient evidence to determine how the type or training of EMS personnel administering naloxone impacted comparisons involving different routes of administration or doses of naloxone.…”

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confidence: 99%

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Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel

Chou¹,

Korthuis²,

McCarty³

et al. 2017

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Key Messages Purpose of ReviewTo determine optimal doses, routes of administration, and dosing strategies of naloxone for suspected opioid overdose in out-of-hospital settings, and whether transport to a hospital following successful opioid overdose reversal with naloxone is necessary. Key Messages• Higher concentration intranasal naloxone may be similarly effective and safe compared with intramuscular naloxone, but the available studies did not evaluate formulations approved by the Food and Drug Administration.• While field administration of naloxone is generally effective in reversing opioid overdose, there is not strong evidence concerning differences in effectiveness between doses or routes of administration.• More research is needed to determine optimal doses of naloxone, appropriate timing of repeat dosing, and whether it is necessary to dose patients to full consciousness.• More research is needed to determine whether transporting patients to a hospital after successful reversal of overdose is necessary.ii This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.This report may periodically be assessed for the currency...

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“…Administration of naloxone by bystanders is reported in over a dozen feasibility studies with reversal rates ranging from 75 to 100 % of cases [15,16,[19][20][21][22][23][24][25][26][27][28][29][30]. Two studies measured the impact of a naloxone program on mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Expanding Access to Naloxone in the United States

2014

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Nasal Administration of Naloxone Is as Effective as the Intravenous Route in Opiate Addicts

Cited by 55 publications

References 10 publications

Naloxone without the needle − systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal

Naloxone without the needle − systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal

Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel

Expanding Access to Naloxone in the United States

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