ABSTRACT SUMMARY:
Intranasal Naloxone for Opiate overdose
Contents Bibliography:
Title:
Barton, E. D., J. Ramos, et al. (2002). "Intranasal administration of naloxone by paramedics." Prehosp Emerg Care 6(1): 54-8.
Kelly, A. M., D. Kerr, et al. (2005). "Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose." Med J Aust 182(1): 24-7.
Loimer, N., P. Hofmann, et al. (1992). "Nasal administration of naloxone for detection of opiate dependence." J Psychiatr Res 26(1): 39-43.
Loimer, N., P. Hofmann, et al. (1994). "Nasal administration of naloxone is as effective as the intravenous route in opiate addicts." Int J Addict 29(6): 819-27.
Hussain, A., R. Kimura, et al. (1984). "Nasal absorption of naloxone and buprenorphine in rats." Int J Pharm(21): 233-237.
Barton, E. D., J. Ramos, et al. (2002). "Intranasal administration of naloxone by paramedics." Prehosp Emerg Care 6(1): 54-8.
INTRODUCTION: Naloxone is a medication that is frequently administered in the field by paramedics for suspected opioid overdoses. Most prehospital protocols, however, require this medication to be given to patients intravenously (i.v.) or intramuscularly (i.m.). Unfortunately, intravenous line placement may be problematic and time-consuming in chronic i.v. drug users. There may also be a delay in patient response to opioid reversal with i.m. absorption of naloxone. Additionally, routine use of needles in high-risk populations poses an increased risk of occupational blood exposures to paramedics. OBJECTIVE: To prospectively test the effectiveness of intranasal (i.n.) naloxone administration by paramedics. This preliminary report summarizes the first month's experience in the city of Denver. METHODS: Naloxone was first administered to patients found unconscious in the field using a nasal mucosal atomizer device (MAD). Patients were then treated using standard prehospital protocols, which included i.v. line placement and medications, if they did not immediately respond to i.n. naloxone. Time to patient response was recorded. RESULTS: A total of 30 patients received i.n. naloxone in the field over a one-month period. Of these, 11 patients responded to either i.n. or i.v. naloxone. Ten (91%) patients responded to i.n. naloxone alone, with an average response time of 3.4 minutes. Seven patients (64%) did not require an i.v. in the field after response to i.n. naloxone. CONCLUSIONS: Intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses in the field. Use of this route may decrease paramedic exposures to blood-borne diseases. The addition of i.n. naloxone administration to prehospital protocols should be considered as an initial therapy for suspected opioid abusers.
Kelly, A. M., D. Kerr, et al. (2005). "Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose." Med J Aust 182(1): 24-7.
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.
Loimer, N., P. Hofmann, et al. (1992). "Nasal administration of naloxone for detection of opiate dependence." J Psychiatr Res 26(1): 39-43.
In clinical trials, nasally applied naloxone was used to identify opiate dependence in humans for the first time. Withdrawal distress was recorded, and pupillary response, pulse rate and blood pressure measured. A significant increase in withdrawal distress and pupillary dilation was observed after nasal administration of 1mg (1mg/400 microliters) naloxone in all subjects who also showed opiate-positive urine samples. In control subjects, no reaction to naloxone was observed. It may be concluded that the nasal route for naloxone administration is as effective as the parenteral route. This test is sensitive enough to identify the physically-dependent opiate user and might have a role in emergency medicine and withdrawal treatment.
Loimer, N., P. Hofmann, et al. (1994). "Nasal administration of naloxone is as effective as the intravenous route in opiate addicts." Int J Addict 29(6): 819-27.
Naloxone is used intravenously in opiate addiction in emergency cases, in rapid opiate detoxification, and as a diagnostic tool. This is a study comparing the efficacy of intranasal naloxone to other routes (intravenous/intramuscular) in 17 opiate-dependent patients. The nasal drug administration of naloxone was found to be as effective as the intravenous route. The nasal drug application offers a wide margin of safety for patients and medical staff, especially in emergency situations in regard to infection risks associated with vessel puncture.
Hussain, A., R. Kimura, et al. (1984). "Nasal absorption of naloxone and buprenorphine in rats." Int J Pharm(21): 233-237.
These authors measured bioavailabillity of naloxone via the IV and the intranasal route in rats and found that the peak levels of naloxone were similar and the bioavailability of naloxone intranasally was 100% (the same) of that available IV.