Low-dose naloxone does not improve morphine-induced nausea, vomiting, or pruritus.
OBJECTIVE
We tested the hypothesis that low-dose naloxone delivered with intravenous (IV) bolus morphine to emergency department patients in pain would reduce nausea.


METHODS
Randomized, double-blind, placebo-controlled trial. Patients receiving 0.10 mg/kg morphine IV bolus rated pain, nausea, and pruritus on 100-mm visual analog scales at enrollment and 20 minutes. Patients were randomized to 0.25 microg/kg naloxone or equal volume placebo administered with IV morphine.


RESULTS
One hundred thirty-one enrolled, 99 (76%) treated according to protocol with sufficient data for analysis. At 20 minutes the difference between groups (naloxone-placebo) was 1 mm (95% CI [confidence interval], -9 to 11) for nausea, 1 mm (95% CI, -3 to 3) for pruritus, 4% (95% CI, -1 to 9) for vomiting, and 0% (95% CI, -5 to 5) for rescue antiemetics. Pain was significantly reduced in both groups.


CONCLUSIONS
Addition of 0.25 microg/kg naloxone to bolus morphine does not improve nausea, pruritus, vomiting, or reduce use of rescue antiemetics when administered to emergency department patients in pain.
Greenwald
Peter W
PW
New York-Presbyterian Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. pg2014@columbia.edu
Provataris
Jennifer
J
Coffey
John
J
Bijur
Polly
P
Gallagher
E John
EJ
D000328:Adult; D000698:Analgesia / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced / Q000188:drug therapy*; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy*
D009292:Narcotic Antagonists; D009270:Naloxone; D009020:Morphine