Naloxone Dosing for Opioid Overdose
The Article: The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty. Conners N, Nelson L. Journal of Medical Toxicology. 2015 12:276-281. DOI 10.1007/s13181-016-0559-3.
The Idea: Opioid prescribing and abuse have increased over the last ten years, causing an associated quadrupling of opioid overdose deaths. Naloxone reverses opioid-induced respiratory depression, but can precipitate withdrawal. Few studies have addressed the optimal dose of naloxone that balances reversal and withdrawal.
The Study: Twenty-five resources updated in the last ten years were reviewed to assess for a consensus on the recommended dose for IV naloxone. Resources included medical textbooks, study guides, Internet resources in internal medicine, emergency medicine, general medicine, medical toxicology, anesthesiology, pediatrics, and pain medicine. Percentages of resources with specific ranges of naloxone doses were calculated.
The Findings: 48% of references recommended a starting dose less than or equal to 0.05 mg. 36% recommend a dose ten-fold higher. The majority of sources, including emergency medicine-specific sources, recommend a low-dose strategy with a starting dose less than 0.05 mg IV. However, there is still great disparity in recommendations amongst the resources reviewed.
The Takeaway: The recommendations for dosing naloxone vary and further study is needed.