Opioid antidote medications flyer

Opioid antidote medications: formulations and appropriate dosing

There are 2 FDA-approved opioid reversal medications: naloxone and nalmefene.

There is limited clinical data regarding the use of nalmefene on patients experiencing opioid overdose and there are concerns that the extended duration of action could result in severe and prolonged opioid withdrawal (ACMT) (Stolbach et al.). At this time, the Philadelphia Department of Public Health does not recommend nalmefene and advise patients and providers to continue to use naloxone, which is effective at reversing opioid overdose.

What is the appropriate dose of naloxone?

The appropriate dose of naloxone is the amount needed to restore breathing. Despite a perception that stronger synthetic opioids require additional naloxone, a study of naloxone administration over 17.6 years demonstrated that 1 to 2 doses of intranasal 4mg naloxone was effective in reversing overdose during a time when the overdose crisis primarily involved prescription opioids, heroin, fentanyl, and xylazine (Desgupta N & Bell A).

What is precipitated withdrawal?

Administering an opioid antagonist to someone who regularly uses an opioid agonist can result in the rapid onset of opioid withdrawal symptoms, which is called precipitated withdrawal. Experiencing precipitated withdrawal after being administered naloxone can lead to increased risk for overdose by making it more likely for people to use drugs alone and less likely for people who use drugs to carry naloxone. The higher the dose of opioid antagonist, the greater the likelihood of precipitated withdrawal.

What is compassionate overdose response?

Compassionate overdose response relies on low-dose naloxone that can be titrated to return breathing without causing precipitated withdrawal. Examples of low-dose naloxone include 0.4mg intramuscular naloxone, 2mg Luer-Lock Prefilled Syringe with atomizing device (intra-nasal), 3mg Revive intra-nasal, 4mg Narcan/Generic intra-nasal. Dosing higher than 4mg intra-nasal is not associated with decreased mortality and is associated with more severe withdrawal.