Intranasal, Intramuscular Naloxone Equally As Effective for Opioid Overdose
One trial found that lower-concentration intranasal naloxone was less effective than intramuscular naloxone.
HealthDay News — For reversal of opioid overdose, higher-concentration intranasal naloxone has similar efficacy to that of intramuscular naloxone administered at the same dose, according to a review published online in the Annals of Internal Medicine.
Roger Chou, MD, from the Oregon Health & Science University in Portland, and colleagues conducted a systematic review to synthesize evidence on the effects of naloxone route of administration and dosing for suspected overdose in out-of-hospital settings, and the need for transport to a health care facility after reversal of overdose with naloxone. Data were included from 13 eligible studies.
The researchers found that one trial demonstrated similar efficacy between higher-concentration intranasal naloxone and intramuscular naloxone administered at the same dose (2 mg/mL). One trial found that lower-concentration intranasal naloxone was less effective than intramuscular naloxone, but the risk for agitation was reduced (low strength of evidence). There was insufficient evidence to assess other comparisons for administration route. Low rates of death and serious adverse events were reported in 6 uncontrolled studies in non-transported patients after successful naloxone treatment.
"Higher-concentration intranasal naloxone (2 mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events," the authors write. "Non-transport after reversal of overdose with naloxone seems to be associated with a low rate of serious harms, but no study evaluated risks of transport vs non-transport."
Chou R, Korthuis PT, McCarty D, et al. Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review [published online November 28, 2017]. Ann Intern Med. doi:10.7326/M17-2224