Pitfalls of intranasal naloxone.
We present a case of failed prehospital treatment of fentanyl induced apnea with intranasal (IN) naloxone. While IN administration of naloxone is becoming more common in both lay and pre-hospital settings, older EMS protocols utilized intravenous (IV) administration. Longer-acting, higher potency opioids, such as fentanyl, may not be as easily reversed as heroin, and studies evaluating IN administration in this population are lacking. In order to contribute to our understanding of the strengths and limitations of IN administration of naloxone, we present a case where it failed to restore ventilation. We also describe peer reviewed literature that supports the use of IV naloxone following heroin overdose and explore possible limitations of generalizing this literature to opioids other than heroin and to IN routes of administration.
Matthew
M
Zuckerman
Stacy N
SN
Weisberg
Edward W
EW
Boyer
D000281:Administration, Intranasal; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced / Q000188:drug therapy*; D001682:Biological Availability; D001794:Blood Pressure / Q000187:drug effects; D062787:Drug Overdose / Q000188:drug therapy*; D004632:Emergency Medical Services; D005283:Fentanyl / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D015877:Miosis / Q000188:drug therapy; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000139:chemically induced / Q000188:drug therapy*; D056152:Respiratory Rate / Q000187:drug effects
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D005283:Fentanyl
intranasal naloxone; overdose; prescription opioids