title: Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone.
abstract: Opioids can induce respiratory depression by invoking a centrally mediated decrease in involuntary respiratory rate, which in severe cases can cause a decrease in oxygen saturation. If respiratory depression is opioid induced, both low respiratory rate and low oxygen saturation will be present. If this is the case, oxygenation, rousing by verbal and physical stimulation and decreasing the opioid dose should be tried first. Naloxone, an opioid antagonist, should be avoided if at all possible but, if essential, titrate slowly to respiratory function administering 20-100 µg intravenously every two minutes. If used as a bolus for a patient on long-term opioids for chronic cancer pain, then refractory pain and symptomatic opioid withdrawal can result.
authors.affiliation: Hull York Medical School, University of Hull, Hull, UK. jason.boland@hyms.ac.uk
authors.forename: Jason
authors.initials: J
authors.lastname: Boland
authors.forename: Elaine
authors.initials: E
authors.lastname: Boland
authors.forename: David
authors.initials: D
authors.lastname: Brooks
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology; D008297:Male; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D010102:Oxygen Inhalation Therapy; D010146:Pain / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D013375:Substance Withdrawal Syndrome / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: cancer pain; naloxone; opioid; respiratory depression