Prehospital naloxone administration – what influences choice of dose and route of administration?
Tylleskär, Ida; Gjersing, Linn; Bjørnsen, Lars Petter Bache-Wiig; Braarud, Anne-Cathrine; Heyerdahl, Fridtjof; Dale, Ola; Skulberg, Arne Kristian
Peer reviewed, Journal article
Published version
Åpne
Permanent lenke
https://hdl.handle.net/11250/2676758Utgivelsesdato
2020Metadata
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Originalversjon
10.1186/s12873-020-00366-3Sammendrag
Background
Amidst the ongoing opioid crisis there are debates regarding the optimal route of administration and dosages of naloxone. This applies both for lay people administration and emergency medical services, and in the development of new naloxone products.
We examined the characteristics of naloxone administration, including predictors of dosages and multiple doses during patient treatment by emergency medical service staff in order to enlighten this debate.
Methods
This was a prospective observational study of patients administered naloxone by the Oslo City Center emergency medical service, Norway (2014–2018). Cases were linked to The National Cause of Death Registry. We investigated the route of administration and dosage of naloxone, clinical and demographic variables relating to initial naloxone dose and use of multiple naloxone doses and one-week mortality.
Results
Overall, 2215 cases were included, and the majority (91.9%) were administered intramuscular naloxone. Initial doses were 0.4 or 0.8 mg, and 15% of patients received multiple dosages. Unconscious patients or those in respiratory arrest were more likely to be treated with 0.8 mg naloxone and to receive multiple doses. The one-week mortality from drug-related deaths was 4.1 per 1000 episodes, with no deaths due to rebound opioid toxicity.
Conclusions
Intramuscular naloxone doses of 0.4 and 0.8 mg were effective and safe in the treatment of opioid overdose in the prehospital setting. Emergency medical staff appear to titrate naloxone based on clinical presentation.