Is Intranasal Naloxone as Effective as Intramuscular Naloxone for Opioid Overdose?

November 14, 2019

By Denise Baez

Intranasal naloxone can reverse opioid overdose, but not as efficiently as intramuscularly-administered naloxone, according to a study published in JAMA Network Open.

The 93 individuals randomised to intramuscular naloxone administration were less likely to require a rescue dose of naloxone 10 minutes after initial treatment compared with the 104 individuals randomised to intranasal naloxone administration (8.6% vs 23.1%; odds ratio [OR] = 0.35; P = .002).

In addition, individuals who received intranasal naloxone took longer to achieve a respiratory rate of at least 10 breaths per minute and a Glasgow Coma Scale score of at least 13.

The study was conducted at the Uniting Medically Supervised Injecting Centre, Sydney, Australia. Clients of the centre were recruited to participate from February 1, 2012, to January 3, 2017. Eligible clients were aged 18 years or older with a history of injecting drug use.

Individuals in the study received intranasal administration of naloxone hydrochloride 800 mcg per 1 mL and intramuscular administration of placebo 1 mL or intramuscular administration of naloxone hydrochloride 800 mcg per 1 mL and intranasal administration of placebo 1 mL.

For intranasal administration, the contents of the vial were drawn into 1 syringe, and the syringe was attached to a mucosal atomisation device. Each nostril received 0.5 mL (400 mcg), with rapid depression of the syringe to achieve adequate atomisation. For intramuscular administration, following the standard practice, the full 1-mL dose was drawn into a single 3-mL syringe and injected into the deltoid muscle with a 23-gauge needle. The order of drug administration was altered approximately midway through the study. Initially, the intranasal route was first, followed by the intramuscular route, but the order was reversed for the second half of the study.

Supportive care or oxygenation was administered simultaneously in accordance with existing clinical protocols. Any client who failed to respond adequately (Glasgow Coma Score remained

“This trial found that the same dose of naloxone given intranasally was not as effective as naloxone given intramuscularly in reversing opioid overdose, suggesting that further work is needed to establish the optimal dose of nasal naloxone,” wrote Paul Dietze, PhD, Burnet Institute, Melbourne, Victoria, Australia, and colleagues.

“Further research is needed to identify whether the larger doses currently given intranasally can achieve the same effects as the recommended doses administered intramuscularly that have been found in pharmacokinetic studies,” the authors added. “Such findings would inform the translation into practice in real-world settings in which opioid overdoses are likely to occur.”


SOURCE: JAMA Network Open