Recommendations for Prehospital Dosing Schedule of Naloxone
Naloxone is a potent antagonist of the binding of opioids to their receptor sites within the brain and spinal cord. Administration of naloxone will reverse the central nervous system and respiratory depression resulting from an opioid overdose (Soar et al., 2005; Soar et al., 2010; Van Hoek et al., 2010). Naloxone has a long established use in prehospital emergency resuscitation of patients with narcotic overdose, and with very little pharmacological effect otherwise, the drug is evidenced to possess very little, if any, negative effect on patient outcomes, particularly in opiate-naive patients (Albertson, 2001; Dollery, 1991; Soar et al., 2005; Soar et al., 2010; Yealy, 1990).
Although naloxone has proven to be effective within the prehospital arena, there is some concern as to the acceptable maximum cumulative dose that one person ought to receive, particularly when suffering cardiac arrest. This literature review aims to address this question and promote evidence-based prehospital guidelines.
Naloxone Dosing in the Patient Presenting with Altered Mental Status
According to the manufacturer, the Food and Drug Administration, and the American Heart Association (AHA), the suggested dosing regimen for naloxone in treating patients with an overdose of opiates is 0.4 to 2.0 mg IV, IM, SC, or IN, repeated every two to three minutes as needed up to a maximum cumulative dose of 10 mg (sometimes required for large or atypical opioid intake) at which time the suspicion of primary narcotic overdose ought to be questioned as the condition may be caused by a drug or disease process that is not responsive to naloxone (Albertson, 2001; DynaMed, 2008; Endo Pharmaceuticals, 2003; “Naloxone,” 2011; Soar et al., 2005; Soar et al., 2010; Van Hoek et al., 2010). Marraffa, Cohen, and Howland (2012) reiterates this cumulative maximum dose while advocating for lower initial dosing:
Efficacy of Naloxone in Opiate-induced Cardiac Arrest
According to the latest AHA guidelines, “naloxone has no role in the management of cardiac arrest” (Van Hoek et al., 2010, “Opioid Toxicity”). This statement, however, is in direct conflict with the AHA's "H's & T's" premise of addressing underlying causes of cardiac arrest, with one of those T's being toxicological in nature and requiring the particular antidote (in this case, naloxone) to aid in the resuscitative effort. As previously mentioned, the AHA guidelines do provide that, when naloxone is indicated, aggressive dosing may be required to reverse intoxication with atypical opioids or following a considerable overdose.
“Briefing Paper Heroin-assisted Treatment: The State of Play.” Idpc.net. Idcp.net, n.d. Web. 4 Jul. 2010.
Naloxone [Narcan] is a structural analog of morphine that acts as a competitive antagonist at opioid receptors, thereby blocking opioid actions. Naloxone can reverse most effects of the opioid agonists, including respiratory depression, coma, and analgesia (Lehne, 2013). Naloxone may be administered IV, IM, Intranasal, or subQ. Following IV injection, effects begin almost immediately and persist about 1 hour. Following IM or subQ injection, effects begin within 2 to 5 minutes and persist several hours (Lehne, 2013).
...n overdose mortality after the opening of North America'ss first medically supervised safer injecting facility: a retrospective population-based study. Lancet, 377(9775), 1429-1437.
As of today this type of treatment is one of the most widely known options for clients who have opiate issues. This treatment is a combination of two different drugs: buprenorphine and naloxone. Buprenorphine is a lower form of opiates that is given to the patient with opiate addictions because it provides them with fewer side effects when coming off the addiction. Naloxone is a blocker medication that is primarily given in emergency rooms to individuals who have overdosed wit...
Opioid addiction is a tragedy that affects countless of Americans on a daily basis. Almost everyone is acquainted to someone, who suffers from opioid addiction. Everyone, but specifically family and friends of the victims to opioid addiction need to understand why their loved ones are so susceptible to becoming addicted to opioids. The word opioid in itself is complex to define, but it entails a variety of prescription medications. Most opioids are used as pain management medications and qualify as CII medications also known as narcotics. They are supposed to be used on an “as needed” basis, but that is not the case for many users of opioids. Opioids cause great fear in the health community because they are easily addictive and
If the drug is being used primarily to treat severe pain not responsive to other analgesics, in a painful terminal condition, (such as advanced widespread cancer), it may ...
In the United States, opioid addiction rates have majorly increased . Between 2000-2015 more than half a million individuals have died from Opioid overdose, and nearly 5 million people have an opioid dependence which has become a serious problem. The Center for Disease control reports that there are 91 deaths daily due to opioid abuse. Taking opioids for long periods of time and in
It isn’t worth spending $54,000 to help save an intravenous drug user’s life, if this is likely to be a reoccurring problem. The issue is just going to occur again and spending money on the same issue is pointless. Everyone deserves to live and mistakes don’t determine someone’s worth, but if you understand the consequences that are faced when being a drug user, you wouldn’t do it over and over again. In the text from, “Heart Infections Spike as Injection-Drug Abuse Climbs: CDC; Typical endocarditis patient is white, young and from a rural area, report says” it states, “Endocarditis is a potentially fatal infection, according to the American Heart Association. And, it’s expensive to treat, with half of patients
The abuse of and addiction to opioids and the current epidemic in America. Opioids are a class of drugs which have been used since ancient times to reduce pain. Although opiates are derived from opium and opioids refer to synthetic drugs created to emulate opium, nowadays the term opioid is used for the entire family of drugs including natural, synthetic and semi-synthetic. Opium is an extract of the exudate derived from seedpods of the poppy plant, Papaver somniferum. The opium poppy is native to the Middle East and was cultivated in lower Mesopotamia.
The dosage of the drug should be used according to the carton instructions. A 10 gram over dose in adults, 140 mg for kids, can cause permanent liver damage. Also if you had just taken some other drugs , The acetaminophen may become more toxic since the drugs are catabolized in the liver. To protect yourself from injury, you should take 1 gram of vitamin C and Cysteine -a bodily antioxidant.
Morphine has been used for many years in different cultures, and for different reasons. It has been abused, demolished, revived, and manufactured. It has saved many lives and ruined many more. It is the drug of choice for many who feel they need something to numb out the bad, and forget about the real. It is also the prescription of choice for men and women who just want to have their lives back. Although morphine addicts go through hell during their withdrawal stages, and how awful the drug can be through abuse, it offers very much to a wide array of patients suffering from diseases such as cancer, severe back pain, kidney stones, and pain associated in trauma.
Hypothermia protocol for the post cardiac arrest patient has been an evidence based practice of this therapy for about a decade now. This intervention, often used in the critical care setting, is now expanding to primary emergency responders as well. This paper will present some of the notable research that has been done on therapeutic hypothermia, and current use of this intervention.
Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494-500.
Aranella, Cheryl, MD., M.P.H. Use of Opiates to Manage Pain in the Seriously and Terminally Ill Patient. American Hospice Foundation, 2006. Web. 7 November 2011.
The Journal of Neuroscience Dobler-Mikola, A. Gschwed, P. Gutzwiller, F. Steffen, T. Rehm, J. Uch engagen, A. Feasibility, Safety, and Efficacy of Injectable Heroin Prescription for Refractory Opioid Addicts: a follow-up study. The Lancet, volume 358, pg. 1417-1420. Everitt, B. Robbins, T. (1999) Drug addiction: bad habits add up. Macmillian Magazines, volume 389, pg.