Safety of Naloxone in Opioid-NaÃ¯ve Methadone Intoxicated Patients; a Case Series Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Studies have shown that naloxone can cause behavioral changes in naÃ¯ve normal volunteers. This study aimed to investigate the possible complications of naloxone in methadone-overdosed opioid-naÃ¯ve patients.
Methods: In this pilot study, a total number of 20 opioid-naÃ¯ve methadone-poisoned patients underwent naloxone challenge test to receive naltrexone. 0.2, 0.6, and 1.2 mg doses of naloxone were administered on minutes 0, 5, and 15-20. The patients were followed for 30 minutes after administration of naloxone and monitored for any upsetting signs and symptoms. Patients with clinical opiate withdrawal scale (COWS) lower than 5 were considered not addicted and the severity of patientsâ€™ symptoms was calculated using subjective opiate withdrawal syndrome (SOWS).
Results: 20 patients with mean age of 25.5Â±8.09 years were evaluated (70% female). Median ingested dose of methadone was 25 mg [IQR; 10 to 50 mg] and mean time interval between ingestion of methadone and naloxone challenge test was 7.1Â±4.9 hours. Fourteen patients reported some discomfort after administration of a mean dose of 1.7Â±0.5 mg of naloxone lasting for a maximum of four hours. The most common patientsâ€™ complaints were headache (45%) followed by nausea (20%), agitation (20%), abdominal pain (20%), and flushing (20%). Two (10%) mentioned severe panic attack and sensation of near-coming death. SOWS significantly correlated with female gender (p = 0.004) and time elapsed post methadone ingestion (p = 0.001).
Conclusion: It seems that naloxone is not a completely safe medication even in opioid-naÃ¯ve patients, and administrating adjusted doses of naloxone even in opioid-naÃ¯ve methadone intoxicated patients may be logical.
- Substance Withdrawal Syndrome
- Drug-Related Side Effects and Adverse Reactions
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