UMEM Educational Pearls

Title: Nebulized Naloxone: What Does the Literature Say?

Keywords: naloxone, nebulized, opioid (PubMed Search)

Posted: 7/30/2013 by Bryan Hayes, PharmD (Updated: 8/8/2013)
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Naloxone can be administered via pretty much any route. One that has gained popularity in the past several years is nebulized naloxone. Although anecdotal reports tout the benefits of nebulized naloxone, what does the literature say?

Case report of 46 y/o f with initial oxygen saturation of 61%. Naloxone was administered by nebulizer and within 5 min oxygen saturation was 100% and mental status was normal. [1]
Retrospective analysis of prehospital adminstration in 105 patients. 22% had "complete response" and 59% had "partial response." Problem is the initial respiratory rate was 14 bpm with GCS of 12. [2]
Prospective analysis of 26 patients in an inner-city, academic ED. Pre-naloxone respiratory rate was 13 with GCS of 11. Post-naloxone respiratory rate was 16 with GCS of 13. Three patients (12%) experienced moderate-to-severe agitation and 2 (8%) were diaphoretic. [3]

Bottom Line: Many of the studied patients may not have needed naloxone in the first place (initial respiratory rate 13-14), with a few developing withdrawal symptoms. Nebulized naloxone may have a role in the not-too-sick opioid overdose in whom you want to prove your diagnosis and wake the patient up enough to obtain a history. It is not a therapy for the apneic opioid overdose.

References

1. Mycyk MB, et al. Nebulized naloxone gently and effectively reverses methadone intoxication. J Emerg Med 2003;24(2):185-7. [PMID 12609650]

2. Weber JM, et al. Can nebulized naloxone be used safely and effectively by emergency medical services for suspected opioid overdose? Prehosp Emerg Care 2013;16(2):289-92. [PMID 22191727]

3. Baumann BM, et al. Use and efficacy of nebulized naloxone in patients with suspectd opioid intoxication. Am J Emerg Med 2013;31(3):585-8. [PMID 23347721]

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