Acute Crit Care.  2020 Feb;35(1):38-43. 10.4266/acc.2020.00010.

Comparison of the efficacy of an infusion pump or standard IV push injection to deliver naloxone in treatment of opioid toxicity

• Dadpour B
• Vahabzadeh M
• Mostafazadeh B

• KMID: 2500949
• DOI: http://doi.org/10.4266/acc.2020.00010

Abstract

Background
The optimal goal of naloxone infusion in intensive care units is to ameliorate opioid-induced side effects in therapy or eliminate the symptoms of opioid toxicity in overdoses. Accurately monitoring and regulating the doses is critical to prevent adverse effects related to naloxone administration. The present study aimed to compare treatment outcomes when using two methods of intravenous naloxone infusion: an infusion pump or the standard method. Methods: This study involved 80 patients with signs and symptoms of opioid overdose. The patients were randomly assigned into two groups with respect to intravenous infusion of naloxone by either an infusion pump or the standard method. Results: Comparison of study parameters between the two groups at 12 and 24 hours after intervention showed significantly more compensatory acid-base imbalance in the naloxone infusion pump group. In the group that received naloxone by pump, only one patient experienced withdrawal symptoms, but withdrawal symptoms appeared in 12 patients (30.0%) in the standard intravenous infusion group within 12 hours and in seven additional patients (17.5%) within 24 hours of intervention. In the group receiving pump-based naloxone infusion therapy, no another complications were reported; however in the standard infusion group, the 12-hour and 24-hour complication rates were 55.0% and 32.5%, respectively. The length of hospital stay was 2.85±1.05 and 4.22±0.92 days for the pump and standard infusion groups, respectively (P<0.001). Conclusions: Naloxone infusion using an infusion pump may be safer with regard to hemodynamic stability, resulting in shorter hospitalization periods, and fewer posttreatment complications.

Keyword

Acid-base imbalance; Infusion pumps; Intensive care unit; Naloxone; Opioid; Treatment outcome

Reference

1. Centers for Disease Control and Prevention (CDC), Prevention (CDC). Community-based opioid overdose prevention programs providing naloxone: United States, 2010. MMWR Morb Mortal Wkly Rep. 2012; 61:101–5.

2. Rzasa Lynn R, Galinkin JL. Naloxone dosage for opioid reversal: current evidence and clinical implications. Ther Adv Drug Saf. 2018; 9:63–88.

3. Smith JO, Malinowski SS, Ballou JM. Public perceptions of naloxone use in the outpatient setting. Ment Health Clin. 2019; 9:275–9.

4. World Health Organization. Community management of opioid overdose. Geneva: World Health Organization;2014.

5. Ramrakha PS, Moore KP, Sam AH. Oxford handbook of acute medicine. 4th ed. Oxford: Oxford University Press;2019.

6. Nolan J. Advanced life support. 5th ed. London: Resuscitation Council (UK);2006.

7. Twycross R, Wilcock A, Howard P. Palliative care formulary. 5th ed. Nottingham: Palliativedrugs.com;2014.

8. Hameln Pharmaceuticals Ltd. Summary of product characteristics: Naloxone 400 micrograms/ml solution for injection or infusion [Internet]. Gloucester: Wockhardt UK Ltd;2019. [cited 2020 Jan 12]. Available from: https://www.medicines.org.uk/emc/product/6344/smpc.

9. Hameln Pharmaceuticals Ltd. Naloxone 400 micrograms/ml solution for injection/infusion [Internet]. Gloucester: Hameln Pharmaceuticals Ltd;2019. [cited 2020 Jan 12]. Available from: https://www.medicines.org.uk/emc/product/6344/smpc.

10. Wermeling DP. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Ther Adv Drug Saf. 2015; 6:20–31.

11. Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Goldfrank’s toxicologic emergencies. 11th ed. New York: McGraw-Hill Education;2019.

12. Cepeda MS, Africano JM, Manrique AM, Fragoso W, Carr DB. The combination of low dose of naloxone and morphine in PCA does not decrease opioid requirements in the postoperative period. Pain. 2002; 96:73–9.

13. Cepeda MS, Alvarez H, Morales O, Carr DB. Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects. Pain. 2004; 107:41–6.

14. Sartain JB, Barry JJ, Richardson CA, Branagan HC. Effect of combining naloxone and morphine for intravenous patientcontrolled analgesia. Anesthesiology. 2003; 99:148–51.

15. Monitto CL, Kost-Byerly S, White E, Lee CK, Rudek MA, Thompson C, et al. The optimal dose of prophylactic intravenous naloxone in ameliorating opioid-induced side effects in children receiving intravenous patient-controlled analgesia morphine for moderate to severe pain: a dose finding study. Anesth Analg. 2011; 113:834–42.

16. Nuckols TK, Bower AG, Paddock SM, Hilborne LH, Wallace P, Rothschild JM, et al. Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. J Gen Intern Med. 2008; 23 Suppl 1:41–5.

17. Waterson J, Bedner A. Types and frequency of infusion pump alarms and infusion-interruption to infusion-recovery times for critical short half-life infusions: retrospective data analysis. JMIR Hum Factors. 2019; 6:e14123.