The following is a summary of “Systematic Review of Naloxone Dosing and Adverse Events in the Emergency Department,” published in the September 2023 issue of Emergency Medicine by Yugar, et al.

No clear dosage guidelines exist inside the ED, even though experts urge using the lowest effective dose of naloxone to balance the reversal of opioid-induced respiratory depression and prevent precipitated opioid withdrawal. This literature study assessed the present state of naloxone dose in the ED and its relationship to adverse outcomes. Researchers searched PubMed and PubMed Central for Embase references to PubMed. Two separate reviewers extracted data from articles detailing the first ED dosage and patient outcome at the patient level. Patients were classified as low-dose ([LD], 0.4 mg), standard-dose ([SD], 0.4-2 mg), or high-dose ([HD], > 2 mg) based on their first i.v. naloxone administration. Their outcomes were the dosage range provided and adverse events per dose. They compared the two groups by calculating the chi-squared difference in proportions or using Fisher’s exact test.

The study included 13 publications with 209 patients in the results analysis: 111 patients in LD (0.04-0.1 mg), 95 in SD (0.4-2 mg), and 3 in HD (4-12 mg). At least one adverse event was observed in 37 SD patients (38.9%), compared with 14 in LD (12.6%, p < 0.0001) and 2 in HD (100.0%, p = 0.16). About 53 patients with SD (55.8%) received at least one extra dosage, compared to 55 patients with LD (49.5%, p<0.0001) and 3 patients with HD (100.0%, p = 0.48).

It’s possible that using naloxone at a lower dosage in the ED might help decrease the number of unintended consequences without requiring more of the drug. Lower dosages of naloxone that are still effective in reversing opioid-induced respiratory depression without triggering precipitated opioid withdrawal should be studied in the future.

Source: sciencedirect.com/science/article/abs/pii/S0736467923003025