The nebulization of naloxone provides a unique and effective way to reverse opioid intoxication by a needleless and noninvasive approach. (Am J Emerg Med. 2013;31:585.) Nebulized naloxone allows the patient to self-titrate the administration and take off the mask when awake and alert, avoiding violent withdrawal symptoms. (J Community Hosp Intern Med Perspect. 2019;9:422; https://bit.ly/3bcEdhv; J Emerg Med. 2003;24:185.)
Peripheral IV access can also be difficult to obtain in patients with a history of IV drug abuse, making needleless routes of naloxone administration useful. Naloxone administration via the intranasal and sublingual routes is limited by lack of titration to patients' response, so withdrawal is precipitated or an inadequate reversal response is produced. (J Community Hosp Intern Med Perspect. 2019;9:422; https://bit.ly/3bcEdhv.)
Nebulized naloxone has been reported to have a time of onset of two to five minutes. (Prehosp Emerg Care. 2012;16:289.) Naloxone, when administered by the nebulized route, acts at the pulmonary opioid receptors and has systemic absorption, both playing a role in reversing intoxication. Usually 2 mg naloxone is added to 5 mL of normal saline and administered using a standard nebulizer mask (the side ports are partially occluded with tape to decrease the escape of nebulized naloxone). (Ann Pharmacother. 2018;52:495.)
The minimum respiratory rate that will still allow successful resuscitation with nebulized naloxone administration has yet to be determined.
This Clinical Pearl first appeared on EMedHome.com. Subscribers receive a new clinical pearl emailed to them every Wednesday. Visitwww.EMedHome.com.
EMedHome.com on EM-News.com
Visit our website for videos and podcasts from Amal Mattu, MD, and other noted emergency physicians from EMedHome.com and EMedHome's video lectures at http://bit.ly/EMN-EMedHomeVideos.
This Month's Video
Mimi Lu, MD: The Critically Ill Obese Child: http://bit.ly/EMN-EMedHomeVideos. Dr. Lu is a clinical assistant professor and the director of pediatric emergency medicine education at the University of Maryland.
This Month's Podcast
Amal Mattu, MD, and Colleagues: Type 2 Myocardial Infarction, Acute Severe Hypertensive Crises and Urgencies, Fournier's Gangrene, and Reperfusion Therapy: http://bit.ly/MattuEMN. Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.