Naloxone was developed in the early 1960s as a novel opioid antagonist with fewer side effects than its predecessors. This review will evaluate the literature to address the question of optimal naloxone dosing to reverse opioid-induced respiratory depression while minimizing patient risk. 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. 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. 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.
5 – 8 There is concern about the precipitation of opioid-withdrawal syndrome following its administration in the setting of prior opioid exposure. Naloxone overall is a safe medication, and is not known to cause harm when administered in typical doses to opioid-naïve patients. 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. 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. 1 Opioid overdose induces respiratory depression that can lead to hypoxia, hypercarbia and death. Opioid overdoses have quadrupled in the past 15 years, and in 2015 there were over 33,000 opioid-related deaths in the United States.
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