Keys to the safe use of naloxone

4 out of 5 stars Reducing the harm of opioid overdose with the safe use of naloxone: a pharmacologic review. Kim HK, Nelson LS. Expert Opin Drug Saf 2015 Apr 12:1-10 [Epub ahead of print] Abstract This review of naloxone comes down strongly on the side of “less is more,” and argues that when reversing opiate overdose a starting dose of 2 mg — or even 0.4 mg — is unnecessary and risks precipitating acute opiate withdrawal syndrome (OWS). Although some clinicians will not agree with all the authors’ opinions, they are well thought out and worth considering. Some key points: Naloxone’s duration of action can vary but is generally from 20-90 minutes. After receiving naloxone, adults should be observed at least 4-6 hours for recurrent respiratory depression. Since children may metabolize opiates more slowly than adults, they should be observed for 24 hours after getting naloxone. Although rare, risks of precipitating OWS with naloxone include aspiration, acute respiratory distress syndrome, hypertensive crisis, ventricular dysrhythmias, and death. Since animal studies indicate that high pCO2 increases catecholamine surge after naloxone administration, the authors recommend a period of assisted ventilation (by bag-valve-mask) in an apneic patient before treating with naloxone. Reversal of respiratory depression — not CNS depression — should be the goal of naloxone therapy. Supplemental oxygen should not be given to opioid overdose patients unl...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical antidote naloxone narcan opiate overdose opioid intoxication Source Type: news