Treatment with naloxone

Naloxone reverses overdose from all opioids, including heroin, morphine, methadone, pentazocine, propoxyphene, dextromethorphan, nalline, and diphenoxylate, without inducing respiratory depression even in the absence of opiates. Therefore it can be used in the mixed or unknown overdose where it can be both diagnostic and therapeutic.

Naloxone administration is indicated when the patient presents signs of central nervous system depression and hypoventilation or respiratory arrest, or as a diagnostic tool when the etiological agent for overdose is unclear. When there is no sign of respiratory depression and the neurological status is only slightly compromised, the administration of supportive therapy with careful clinical observation may be sufficient.

The initial dose of naloxone most frequently recommended for opiate intoxication is an intravenous bolus of 0.4 to 2 mg. This dose can be also given intralingually or intratracheally in the absence of vascular access. Larger doses may be necessary to reverse opiate effects completely; however, if a cumulative dose of 10 mg has been administrated without response, the diagnosis of opiate overdose must be questioned.

The effective naloxone dose may have to be readministered every 30 to 60 min because of the much longer half-life of most opiates.

In the treatment of an overdose of long-acting opioids, a continuous infusion of naloxone should be used after the initial bolus, with two-thirds of the initial dose administered on an hourly basis. As naloxone requirements can vary during the infusion period, close monitoring of the patient is always required.

Although naloxone-induced pulmonary edema has been reported in healthy young subjects after general anesthesia, few adverse effects have been reported for the treatment of opiate overdose apart from agitation and acute withdrawal crisis for large doses of naloxone.

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