Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses

Merlin, Mark A.; Saybolt, Matthew D.; Kapitanyan, Raffi; Alter, Scott M.; Jeges, Janos; Liu, Junfeng; Calabrese, S; Rynn, Kevin O.; Perritt, Rachael; Pryor, Peter W.

doi:10.1016/j.ajem.2008.12.009

Cited by 69 publications

(45 citation statements)

References 22 publications

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“…However, obtaining IV access in the prehospital setting, especially among injection drug abusers, can be time-consuming and difficult [Sporer et al 1996;Barton et al 2002]. A series of studies, beyond the scope of this paper, describe comparative EMS clinical studies of various naloxone doses and routes of administration, including offlabel administration of naloxone injection as an intranasal (IN) spray [Barton et al 2005;Belz et al 2005;Osterwalder 1996;Robertson et al 2009;Wanger et al 1998;Kelly et al 2005;Kerr et al 2008Kerr et al , 2009Merlin et al 2010;Yealy et al 1990]. Times to drug administration and revival show comparable efficacy of the tested dosing methods.…”

Section: Efficacy Of Naloxone Injectionmentioning

confidence: 99%

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Wermeling

2015

Therapeutic Advances in Drug Safety

134

101

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Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/ emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms: intravenous administration and higher doses produce more adverse events and more severe withdrawal symptoms in those individuals who are opioid dependent. More serious adverse reactions after naloxone administration occur rarely and may be confounded by the effects of other co-intoxicants and the effects of prolonged hypoxia. One component of the new opioid harm reduction initiative is to expand naloxone access to high-risk individuals (addicts, abusers, or patients taking high-dose or extended-release opioids for pain) and their close family or household contacts. Patients or their close contacts receive a naloxone prescription to have the medication on their person or in the home for use during an emergency. Contacts are trained on overdose recognition, rescue breathing and administration of naloxone by intramuscular injection or nasal spraying of the injection prior to the arrival of emergency medical personnel. The safety profile of naloxone in traditional medical use must be considered in this new context of outpatient prescribing, dispensing and treatment of overdose prior to paramedic arrival. New naloxone delivery products are being developed for this prehospital application of naloxone in treatment of opioid overdose and prevention of opioid-induced mortality.

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Section: Efficacy Of Naloxone Injectionmentioning

confidence: 99%

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Wermeling

2015

Therapeutic Advances in Drug Safety

134

101

View full text Add to dashboard Cite

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“…Eine australische Arbeitsgruppe stellte keinen Unterschied bezüglich der analgetischen Wirkung zwischen i. v. verabreichtem Morphin und intranasal verabreichtem Fentanyl fest [15]. Bei der präklinischen Therapie von Opioidintoxikationen konnte die Arbeitsgruppe um Merlin und Mitarbeiter zeigen, dass die Eff ektivität der intranasalen Applikation von Naloxon mit der i. v. Gabe vergleichbar war [16].…”

Section: Notfallmedizinische Besonderheitenunclassified

Adipositas im Rettungsdienst - Was ist zu beachten?

Kruska

Kappus²,

Kerner³

2012

Anästhesiol Intensivmed Notfallmed Schmerzther

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The prevalence of obesity has increased steadily in recent years. Obese people often suffer from diseases which acute decompensation requires a prompt prehospital therapy. The Emergency Medical Service will be confronted with difficulties in clinical diagnostic, therapy and especially with a delayed management of rescue and transport. It is most important to avoid prehospital depreciation in quality and time management. This article reviews the specific requirements of prehospital care of obese persons and discusses possible solutions to optimize the prehospital therapy.

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“…To av de ni studiene som undersøkte effekt av nalokson nesespray var prospektive kohortstudier uten sammenligningsgruppe (13,14), to var evalueringer av nalokson som et lavterskeltiltak (15,16), én var en liten pilotstudie (17), to var retrospektive journalgjennomganger (18,19) og to var randomisert-kontrollerte studier (20,21). Tabell 1 gir en oversikt over de fire sistnevnte studier med kontrollgruppe, Tabell 2 oppsummerer de resterende fem studier på nalokson nesespray uten kontrollgruppe.…”

Section: Studier På Nalokson Nesesprayunclassified

“…20 minutter til naloksonvirkning i begge gruppene. Dette funnet ble bekreftet i en annen retrospektiv sammenligning, men her hadde flere i nesespray gruppen behov for ekstra nalokson (18).…”

Section: Studier På Nalokson Nesesprayunclassified

Nalokson nesespray kan redusere risikoen for dødelige heroinoverdoser

Lobmaier¹,

Dalsbø²,

Clausen³

2011

Nor J Epidemiol

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SAMMENDRAGBakgrunn: Antall overdosedødsfall blant heroinmisbrukere i Norge er høyt. Behandling med motgiften nalokson er kun tilgjengelig gjennom helsepersonell. Nalokson kan også gis som nesespray av ikke helsepersonell. Økt tilgjengelighet av nalokson kan redusere både antall fatale overdoser og fare for stikkskader og blodsmitte med hepatitt C og hiv blant helsepersonell. I denne artikkelen presenterer vi kunnskap om bruk av nalokson nesespray i behandling av opioidoverdoser. Material og metode: Vi har gjennomført søk etter relevant forskning om effekt av nalokson nesespray i databasene Medline, Embase og Cochrane library. Artikler er valgt ut basert på skjønn og forhåndsbestemte kriterier om behandling og pasientpopulasjon. Det var ingen restriksjoner på hvilken studiedesign som var benyttet eller metodologisk kvalitet. Konklusjonen er basert på innhentet material. Resultater: Ni relevante studier ble identifisert og inkludert, hvorav fire hadde kontrollgrupper men kun to var randomiserte sammenligninger. Ingen av studiene var utført i Norge. Nalokson nesespray gitt grunnet mistanke om opioidoverdose synes å føre til rask klinisk respons. Ved sammenligning med dagens praksis med injisert nalokson peker funn mot nesten like rask normalisering av åndedrett ved nesespray. Bruk av nalokson nesespray kan gi redusert behov for nalokson injeksjoner og derfor redusert fare for stikkskade blant helsepersonell. Hvis også legfolk utenom helsepersonell laeres opp til å gi nalokson nesespray vil tilgjengeligheten av motgift og kunnskap rundt forebygging av overdoser kunne økes. Fortolkning: Det er foreløpig for få studier av høy kvalitet til å kunne konkludere endelig med effekt av nesespray. Men de studiene som foreligger tyder på at nalokson i form av nesespray kan vaere effektiv i behandlingen av overdoser. Nalokson nesespray anbefales derfor utprøved ytterligere i randomiserte studier i Norge sammenlignet med dagens praksis. Videre bør opplaeringen i bruk for pårørende, brukere og ansatte i eksisterende lavterskeltiltak evalueres da dette vil kunne øke nalokson tilgjengeligheten og bidra til å redusere antallet overdosedødsfall.Lobmaier PPK, Dalsbø TK, Clausen T. Nasal naloxone may reduce the risk of death from heroin overdose.Nor J Epidemiol 2011; 21 (1): 107-111. ENGLISH SUMMARY Background:The number of overdose deaths among heroin users in Norway is high. Treatment with the opioid antidote naloxone is available only through trained health care staff. Naloxone can also be administered as nasal spray by non-health care staff. Increasing naloxone availability may reduce both the number of overdose deaths, the risk of needlestick injuries and the transmission of blood-borne viruses such as Hepatitis C and HIV. This paper reviews the use of nasal naloxone for the treatment of opioid overdose. Material and method:We have conducted a scoping search for relevant literature on the effects of naloxone nasal spray in the electronic databases Medline, Embase and The Cochrane Library. The reports that were judged relevant base...

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Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses

Cited by 69 publications

References 22 publications

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Adipositas im Rettungsdienst - Was ist zu beachten?

Nalokson nesespray kan redusere risikoen for dødelige heroinoverdoser

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