Opioid Antagonist in the Treatment of Ischemic Stroke

Abstract

Stroke is a leading cause of death and disability, and novel treatments need to be found, particularly drugs with neuroprotective and restorative effects. Lately, there has been an increased interest in the relationship between opioids and ischemic stroke. To further appreciate this association between opioids and stroke, we conducted a systematic review to investigate anti-opioid medication’s effectiveness in treating ischemic stroke. We used PubMed advanced-strategy and Google Scholar searches and only included full-text clinical trials on humans and written in the English language. After applying the inclusion/exclusion criteria, seven clinical trials were reviewed. Only one of the naloxone and nalmefene clinical trials showed statistically favorable results. Overall, the nalmefene clinical trials used more updated measures (NIHSS, GOS) to evaluate recovery and functional status in ischemic stroke patients than the naloxone clinical trials. There was less bias in the nalmefene clinical trials. Animal and in vitro studies have showed promising results. Additional research should be conducted with new clinical trials of both drugs with larger samples in patients less than 70 years old and moderate to severe infarcts.

A systematic-search-and-review of registered pharmacological therapies investigated to improve neuro-recovery after a stroke

“…Eight studies of opioid antagonists in stroke were reviewed. A systematic review published in 2021 that included four studies on naloxone ( n = 96) and three studies on nalmefene ( n = 916) was selected ( 69 ). From this review, one small study ( n = 44) on naloxone showed benefit on Neurological Status Score at 2 weeks ( p < 0.01) and one study ( n = 236) on nalmefene showed improvement on Glasgow Coma Scale (GCS) at 10 days ( p < 0.05) and NIHSS at 20 days ( p < 0.05) compared to controls (LOE C-LD).…”

Fentanyl Overdose Presented with Unconsciousness, Hypoxia, Hypotension and Pinpoint Pupil Complicated by Acute Kidney Injury and Right Hemiparesis: A Rare Case Report

“…Hence, this patient confirmed the fact that "drug addicts commonly take more than one drug with or without alcohol". Cerebrovascular accident was not commonly associated with narcotic addiction [12,11]. cerebral hemorrhage with amphetamine [3].…”

“…cerebral hemorrhage with amphetamine [3]. and cerebral infarction with opioids [11,12]. This patient was 28 years old and he had left hemiparesis.…”

Therapeutic Effects of Naloxone Combined with Edaravone on Elderly Patients with Acute Cerebral Infarction

“…With a higher affinity than that of morphine, naloxone binds morphine receptors in the brain to inhibit the action of $-endorphin, the most active endogenous opioid. Then it inactivates $-endorphin, relieves transmission failure and reverses neurological dysfunction induced by the ischemic penumbra in brain tissue areas with edema 6 . Meanwhile, naloxone increases blood flow in ischemic areas, inhibits arachidonic acid metabolism, regulates the balance of prostacyclin and thromboxane, improves microcirculation, alleviates reperfusion injury and cerebral oedema and promotes the recovery of ischemic neuronal function 7 .…”