A dosing nomogram for continuous infusion intravenous naloxone

Goldfrank, Lewis R.; Weisman, Richard; Errick, Jeffrey Keith; Lo, Man Wai

doi:10.1016/s0196-0644(86)80994-5

Cited by 111 publications

(43 citation statements)

References 9 publications

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“…First, we measured effects of naloxone on hedonic and pain responses 3 min after bolus administration. We decided to use a short measurement window, compared with other studies, since naloxone is well known for its rapid onset of action, rate of elimination, and distribution being administered in clinical settings in 2-3 min intervals (Ngai et al, 1976;Goldfrank et al, 1986). Although this methodological limitation does not allow for verification of complete receptor blockage by the time of measurement, the significant effects of naloxone on subjective pain ratings support at least a partial blockage of endogenous painmodulatory mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Pleasure-Related Analgesia Activates Opioid-Insensitive Circuits

Kut

Candia²,

Overbeck³

et al. 2011

J. Neurosci.

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Recent findings suggest that pain and pleasure share common neurochemical circuits, and studies in animals and humans show that opioid-mediated descending pathways can inhibit or facilitate pain. We explored the role of endogenous opioid neurotransmission in pleasure-related analgesia. -Opioidergic activity was blocked with 0.2 mg/kg naloxone to assess its effects on hedonic responses to pleasant emotional pictures (International Affective Picture System) and its modulating effects on heat pain tolerance. Naloxone did not alter subjective and autonomous reactions to pleasure induction or overall mood of participants. In addition, pleasure-related increases in pain tolerance persisted after reversal of endogenous -opioidergic neurotransmission. Subjective pain intensity and unpleasantness ratings increased after naloxone administration. These findings suggest that, in addition to opioid-sensitive circuits, mainly opioidinsensitive pain-modulating circuits are activated during pleasure-related analgesia.

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Section: Discussionmentioning

confidence: 99%

Pleasure-Related Analgesia Activates Opioid-Insensitive Circuits

Kut

Candia²,

Overbeck³

et al. 2011

J. Neurosci.

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“…Recommendations from this study are that 2/3 of the initial bolus dose of naloxone necessary to reverse respiratory depression should be administered every hour as an infusion. A repeat bolus of half the initial dose can be administered 15 minutes after the first to maintain a steady state of opioid antagonism [14]. The pediatric literature also supports use of naloxone infusion to reverse coma and respiratory depression following exposure to opioids, including suboxone [15].…”

Section: What Are the Appropriate Dosages For The Opioid Antagonists mentioning

confidence: 97%

“…The implications of this pharmacological effect are that patients may require repetitive naloxone doses to maintain an alert mental status. A 2-phase clinical trial was undertaken to determine the optimal dosing regimen for continuous naloxone infusion to prevent recurrent respiratory depression [14]. Recommendations from this study are that 2/3 of the initial bolus dose of naloxone necessary to reverse respiratory depression should be administered every hour as an infusion.…”

Section: What Are the Appropriate Dosages For The Opioid Antagonists mentioning

confidence: 99%

Case files of the University of Massachusetts Fellowship in Medical Toxicology: Lethal dose of opioids contained in an elastomeric capsule labeled as vancomycin

Courtney

Boyer

2008

J. Med. Toxicol.

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A 67-year-old man presented to the emergency department (ED) with an alteration in mental status. His past medical history included hypertension, hyperlipidemia, vitamin B 12 deficiency, and recurrent cellulitis. In addition to aspirin, atorvastatin, cyanocobalamin, and multivitamins, he received vancomycin 1 g IV every 12 hours via a peripherally inserted central catheter for MRSA cellulitis. Approximately 30 minutes after his wife began his most recent infusion of vancomycin, the patient began slurring his speech. When he became difficult to arouse, his wife activated Emergency Medical Services. The ambulance crew found the patient to be somnolent, but arousable, and breathing adequately. During transport to the ED, however, the patient became unresponsive and had depression in respiratory effort to the point that he required assisted ventilation with supplemental oxygen.On arrival to the ED the patient's vital signs were: pulse 110 per minute, blood pressure 173/83 mmHg, respiratory rate 4 per minute, oxygen saturation 57% while being assisted with 100% oxygen via bag valve mask, and temperature 36.1Њ C. On physical examination, there were no signs of physical trauma and pupils were 1-2 mm bilaterally. The patient had agonal respirations with rhonchi heard throughout the lung fields. Other than tachycardia, the cardiovascular and abdominal exams were without gross abnormalities. His skin was ashen, cool, and dry, with delayed capillary refill. The neurological examination showed no spontaneous movements and no response to painful stimuli. Because 2.2 mg IV naloxone produced no improvement in respiratory depression, the patient was endotracheally intubated. Although the patient's wife denied access to or the use of narcotics, the patient's qualitative comprehensive urine toxicology screen (which could identify 1043 drugs and other chemicals) detected morphine, codeine, and naloxone.

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“…OxyContin) should be admitted to the hospital for extended observation. When reversing the effects of longer-acting opioids, a continuous infusion of naloxone may be necessary to prevent recurrent toxicity [14,22,27]. In one case report, a 17 year old patient with methadone overdose received a total of 3.2mg of naloxone IV boluses over a 13-hour period but continued to revert back to unconsciousness with periods of apnea.…”

Section: Post-naloxone Administrationmentioning

confidence: 99%

“…In a pharmacokinetic study, Goldfrank et al provided a dosing nomogram for those who require prolonged opioid antagonism with naloxone. The authors suggested using an hourly continuous infusion rate that is 66% of the initial administered bolus dose to prevent recurring opioid toxicity [27]. Overall, the duration of observation following naloxone administration to treat opioid overdose should be based on the half-life of the ingested opioid, the patient's vital signs, oxygen saturation, mental status, and the physician's clinical judgment [11,14,22,25].…”

Section: Post-naloxone Administrationmentioning

confidence: 99%

Use of naloxone for the management of opioid overdose

guyen¹

2012

iosrphr

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Abstract--Opioid overdose is a potentially life-threatening condition that requires immediate medical attention, often landing affected individuals into the emergency department. The longstanding treatment for opioid overdose has been naloxone, a pure opioid antagonist that reverses all signs of opioid intoxication. While effective as a reversal agent, naloxone has a half-life which is shorter than all opioids. Once the effect of naloxone wears off, patients may experience recurrence of opioid intoxication and the consequences can be fatal. The objective of this article is to review the available literature that addresses routes of administration and doses of naloxone as well as the necessary duration of observation when treating patients who present with opioid overdose. The preferred route of administration remains intravenous with intramuscular and intranasal considered alternatives. Recommended dosing is dependent upon history and the opioid being reversed; however, doses range from 0.05 -2 milligrams. A literature search revealed a relatively small number of studies related to observation periods following naloxone administration and subsequent recurrence of opioid toxicity. The available literature supports incorporation of a two-hour observation period following administration of naloxone for short-acting opioids and a longer four to six hour observation period for reversal of long-acting opioids.

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A dosing nomogram for continuous infusion intravenous naloxone

Cited by 111 publications

References 9 publications

Pleasure-Related Analgesia Activates Opioid-Insensitive Circuits

Pleasure-Related Analgesia Activates Opioid-Insensitive Circuits

Case files of the University of Massachusetts Fellowship in Medical Toxicology: Lethal dose of opioids contained in an elastomeric capsule labeled as vancomycin

Use of naloxone for the management of opioid overdose

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