Double-Blind, Randomized Study of Nalmefene and Naloxone in Emergency Department Patients With Suspected Narcotic Overdose

Kaplan, Justin L.; Marx, John A.; Calabro, Joseph J; Gin-Shaw, Susan L; Spiller, James D; Spivey, William L; Gaddis, Gary M.; Zhao, Ning; Harchelroad, Fred

doi:10.1016/s0196-0644(99)70270-2

Cited by 64 publications

(52 citation statements)

References 10 publications

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“…Taken together, these data support the conclusion that salvinorin A's sedative and postural effects are mediated by -receptors. From a translational perspective, it is of interest that nalmefene doses in this approximate range have been studied clinically and experimentally in humans (Kaplan et al, 1999;Bart et al, 2005), suggesting that pharmacological tools to block salvinorin A effects in humans are currently available. It is interesting that nalmefene has partial agonist effects at human -receptors under certain conditions (Bart et al, 2005); nalmefene's ability to block the actions of a high-efficacy -agonist such as salvinorin A is highly consistent with receptor theory (Roth et al, 2002;Chavkin et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Unconditioned Behavioral Effects of the Powerful κ-Opioid Hallucinogen Salvinorin A in Nonhuman Primates: Fast Onset and Entry into Cerebrospinal Fluid

Butelman¹,

Prisinzano²,

Deng³

et al. 2008

J Pharmacol Exp Ther

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Salvinorin A is the main active component of the widely available hallucinogenic plant, Salvia divinorum. Salvinorin A is a selective high-efficacy -agonist in vitro, with some unique pharmacodynamic properties. Descriptive reports show that salvinorin A-containing products produce robust behavioral effects in humans. However, these effects have not been systematically characterized in human or nonhuman primates to date. Therefore, the present studies focused on the characterization of overt effects of salvinorin A, such as sedation (operationally defined as unresponsiveness to environmental stimuli) and postural relaxation, previously observed with centrally penetrating -agonists in nonhuman primates. Salvinorin A was active in these endpoints (dose range, 0.01-0

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Section: Discussionmentioning

confidence: 99%

Unconditioned Behavioral Effects of the Powerful κ-Opioid Hallucinogen Salvinorin A in Nonhuman Primates: Fast Onset and Entry into Cerebrospinal Fluid

Butelman¹,

Prisinzano²,

Deng³

et al. 2008

J Pharmacol Exp Ther

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“…Nalmefene administration for opioid overdose or respiratory depression has resulted in tachycardia and hypertension in less than 5% of patients [39]. None of these side effects were seen in ours and other studies in healthy subjects receiving nalmefene for HPA axis testing [14,36].…”

Section: Discussionmentioning

confidence: 45%

Stimulation of the Hypothalamic-Pituitary-Adrenal Axis with the Opioid Antagonist Nalmefene

et al. 2005

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“…Naloxone and nalmefene proved to be equally efficacious and safe in patients with suspected opioid overdoses (Kaplan and others 1999). Naloxone has two disadvantages.…”

Section: Discussionmentioning

confidence: 99%

Human exposures to immobilising agents: results of an online survey

2010

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Cases of human exposure to veterinary injectable anaesthetics were reviewed following a literature search and completion of an online questionnaire in an attempt to provide an objective approach to the problem. The modified Glasgow Coma Scale was used to rank cases according to their severity. From the cases examined, results showed that intoxication with potent opioids, such as etorphine, carfentanil and thiafentanil, need to be treated with antagonists such as naloxone, nalmefene or naltrexone, and not with antagonists with agonistic properties, such as diprenorphine. With regard to the alpha(2)-agonists xylazine, detomidine, medetomidine and romifidine, no antagonist is currently accredited for human use. Atipamezole, a specific alpha(2)-antagonist, is widely used in veterinary medicine and has been used experimentally to reverse dexmetomidine in a study in human medicine. The high concentrations of alpha(2)-agonists being used in zoo and wildlife medicine warrant the accreditation of atipamezole for use in cases of human exposure. Knowledge and availability of the appropriate antagonist are essential in cases of human intoxication with injectable anaesthetics. Preventive measures, such as wearing gloves and eye protection, need to be used more regularly to reduce the risk of exposure.

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Double-Blind, Randomized Study of Nalmefene and Naloxone in Emergency Department Patients With Suspected Narcotic Overdose

Cited by 64 publications

References 10 publications

Unconditioned Behavioral Effects of the Powerful κ-Opioid Hallucinogen Salvinorin A in Nonhuman Primates: Fast Onset and Entry into Cerebrospinal Fluid

Unconditioned Behavioral Effects of the Powerful κ-Opioid Hallucinogen Salvinorin A in Nonhuman Primates: Fast Onset and Entry into Cerebrospinal Fluid

Stimulation of the Hypothalamic-Pituitary-Adrenal Axis with the Opioid Antagonist Nalmefene

Human exposures to immobilising agents: results of an online survey

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