Ventricular Tachycardia After Naloxone Administration: a Drug Related Complication? Case Report and Literature Review

Lameijer, Heleen; Azizi, Nasim; Ligtenberg, Jack J. M.; Maaten, Jan C. ter

doi:10.1007/s40800-014-0002-0

Cited by 16 publications

(3 citation statements)

References 13 publications

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“…68,69 Such events have also been reported in response to naloxone in patients with underlying cardiac dysrhythmias 70 as well as during reversal of opioid overdose in PWID, particularly those who also use stimulant drugs such as cocaine or amphetamines. [71][72][73][74] Post-operative naloxone administration precipitated severe hypertension that led to re-bleeding of a cerebral aneurysm. 75 However, sudden death has also occurred following 0.2 mg of naloxone administration to healthy adults with no medical problems after uncomplicated orthopedic surgeries.…”

Section: Severe Cardiovascular Eventsmentioning

confidence: 99%

Naloxone dosage for opioid reversal: current evidence and clinical implications

Lynn

Galinkin

2017

Therapeutic Advances in Drug Safety

264

196

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Current contextOpioid overdoses have quadrupled in the past 15 years, and in 2015 there were over 33,000 opioidrelated deaths in the United States. 1 Opioid overdose induces respiratory depression that can lead to hypoxia, hypercarbia and death. In an attempt to expedite treatment and improve outcomes following overdose, naloxone is increasingly being utilized in a pre-hospital setting by both emergency personnel and prescribed to laypersons for out-of-hospital administration. 2 Efficacy of reversal following naloxone administration by laypersons is high, having been reported at 75-100%, 3 and in general take-home naloxone programs are considered effective for reducing opioid-overdose mortality. 4 Naloxone overall is a safe medication, and is not known to cause harm when administered in typical doses to opioid-naïve patients. [5][6][7][8] There is concern about the precipitation of opioid-withdrawal syndrome following its administration in the setting of prior opioid exposure. Despite the long-standing use of naloxone to reverse the symptoms of opioid overdose or toxicity, appropriate dosing remains controversial, with varying doses recommended over time and by medical specialty. 9 In a hospital setting, this medication is typically administered initially in a low dose, which is then titrated to optimize reversal of opioid-induced respiratory depression while attempting to minimize the risk of withdrawal. 10 In a non-medical setting, the ideal of gradually titrating naloxone to effect is not practical, thus a single standardized initial dose for out-of-hospital naloxone rescue has been sought. This review will evaluate the literature to address the question of optimal naloxone dosing to reverse opioidinduced respiratory depression while minimizing patient risk. HistoryNaloxone was developed in the early 1960s as a novel opioid antagonist with fewer side effects than its predecessors. 11 Naloxone hydrochloride is a competitive mu-opioid receptor antagonist historically used only by trained clinical professionals for the reversal of opioid overdose in an emergency or inpatient setting. It is approved for administration by a variety of routes, including intravenous (IV), intramuscular (IM), subcutaneous (SQ) and intranasal (IN), but is also administered via inhalation following nebulization or endotracheal tube in intubated patients. [12][13][14] Formulations for many other routes of administration are currently under development, including sublingual and buccal. 15 Naloxone is not typically administered orally due Naloxone dosage for opioid reversal: current evidence and clinical implications Rachael Rzasa Lynn and JL Galinkin Abstract: Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduc...

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Section: Severe Cardiovascular Eventsmentioning

confidence: 99%

Naloxone dosage for opioid reversal: current evidence and clinical implications

Lynn

Galinkin

2017

Therapeutic Advances in Drug Safety

264

196

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“…Findings of naloxone-precipitated OWS include pronounced vital sign abnormalities, seizures, pulmonary edema, and cardiac arrhythmias such as ventricular tachycardia. 2 These latter findings are primarily due to the sudden release of catecholamines. 3 In addition, patients suffer the psychological pangs of withdrawal, including dysphoria and drug craving, which often leads to poor decision-making as they search for additional opioids to alleviate these troubling effects.…”

Section: What Is Acute Opioid Withdrawal Syndrome?mentioning

confidence: 99%

Case Studies in Toxicology: Start Low and Go Slow

Chan¹,

Shaker²,

Nelson³

2017

Emerg Med

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“…Higher naloxone doses are associated with a higher incidence of opioid withdrawal symptoms (Purssell et al 2021 ), which may have implications for the utility/acceptability of higher dose formulations. More rarely, cardiovascular effects can also be seen in people who inject high doses of opioids or use stimulants (Cuss et al 1984 ; Hunter 2005 ; Lameijer et al 2014 ; Merigian 1993 ; Osterwalder 1996 ).…”

Section: Naloxonementioning

confidence: 99%

Treatment of opioid overdose: current approaches and recent advances

Britch

Walsh

2022

Psychopharmacology

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Background The USA has recently entered the third decade of the opioid epidemic. Opioid overdose deaths reached a new record of over 74,000 in a 12-month period ending April 2021. Naloxone is the primary opioid overdose reversal agent, but concern has been raised that naloxone is not efficacious against the pervasive illicit high potency opioids (i.e., fentanyl and fentanyl analogs). Methods This narrative review provides a brief overview of naloxone, including its history and pharmacology, and the evidence regarding naloxone efficacy against fentanyl and fentanyl analogs. We also highlight current advances in overdose treatments and technologies that have been tested in humans. Results and conclusions The argument that naloxone is not efficacious against fentanyl and fentanyl analogs rests on case studies, retrospective analyses of community outbreaks, pharmacokinetics, and pharmacodynamics. No well-controlled studies have been conducted to test this argument, and the current literature provides limited evidence to suggest that naloxone is ineffective against fentanyl or fentanyl analog overdose. Rather a central concern for treating fentanyl/fentanyl analog overdose is the rapidity of overdose onset and the narrow window for treatment. It is also difficult to determine if other non-opioid substances are contributing to a drug overdose, for which naloxone is not an effective treatment. Alternative pharmacological approaches that are currently being studied in humans include other opioid receptor antagonists (e.g., nalmefene), respiratory stimulants, and buprenorphine. None of these approaches target polysubstance overdose and only one novel approach (a wearable naloxone delivery device) would address the narrow treatment window.

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Ventricular Tachycardia After Naloxone Administration: a Drug Related Complication? Case Report and Literature Review

Cited by 16 publications

References 13 publications

Naloxone dosage for opioid reversal: current evidence and clinical implications

Naloxone dosage for opioid reversal: current evidence and clinical implications

Case Studies in Toxicology: Start Low and Go Slow

Treatment of opioid overdose: current approaches and recent advances

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