Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose

TLDR: There was no clinical difference in the time interval to respiratory rate > or =10 breaths/min between naloxone 0.4 mg i.v. and naloxin 0.8 mg s.q. for the out-of-hospital management of patients with suspected opioid overdose.

Abstract: Objective: To determine whether naloxone administered IV to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (SQ) Methods: A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out-of-hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate ≥10 breaths/min, and durations of bag-valve-mask ventilation Subjects received either naloxone 04 mg IV (n= 74) or naloxone 08 mg SQ (n= 122), for respiratory depression of <10 breaths/min Results: Mean interval from crew arrival to respiratory rate ≥ 10 breaths/min was 93 ± 42 min for the IV group vs 96 ± 458 min for the SQ group (95% CI of the difference -155, 100) Mean duration of bag-valve-mask ventilation was 81 ± 60 min for the IV group vs 91 ± 48 min for the SQ group Cost of materials for administering naloxone 04 mg IV was $1230/patient, compared with $1070/patient for naloxone 08 mg SQ Conclusion: There was no clinical difference in the time interval to respiratory rate ≥10 breaths/min between naloxone 08 mg SQ and naloxone 04 mg IV for the out-of-hospital management of patients with suspected opioid overdose The slower rate of absorption via the SQ route was offset by the delay in establishing an IV