Selected topic: toxicology
Nebulized Naloxone gently and effectively reverses methadone intoxication

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Abstract

A 46-year-old woman presented to the Emergency Department with lethargy and respiratory depression after ingesting methadone. Initial oxygen saturation of 61% on room air did not improve with supplemental oxygenation. As venous access was initially unobtainable, naloxone was administered by nebulizer. Within 5 min oxygen saturation was 100% and mental status was normal. The patient did not develop severe withdrawal symptoms. Naloxone hydrochloride has been administered by various routes to treat opioid toxicity. Our report describes the successful use of nebulized naloxone for methadone toxicity.

Introduction

Naloxone hydrochloride (Narcan®) is a widely used antidote for the reversal of opioid toxicity. It has been successfully administered by intravenous (i.v.), intramuscular (i.m.), subcutaneous (s.c.), sublingual, intralingual, endotracheal, and nasal routes (1). We describe the successful use of nebulized naloxone in a patient with methadone intoxication. A review of the literature and further considerations regarding naloxone administration by nebulizer for narcotic toxicity are also discussed

Section snippets

Case report

A 46-year-old woman in a methadone maintenance program developed respiratory depression and lethargy shortly after ingesting an unknown quantity of methadone. The methadone clinic confirmed the patient’s daily methadone dose of 75 mg. She was dispensed a 7-day supply (525 mg) of methadone at the start of each week due to her physical disability. Additional medical history included human immunodeficiency virus (HIV) and chronic obstructive pulmonary disease requiring 2–3 L supplemental oxygen by

Discussion

Naloxone administration is indicated for reversal of opioid anesthesia, in cases of respiratory or central nervous system (CNS) depression from known opioid overdose, or in cases of respiratory or CNS depression when opioid overdose is suspected 1, 2, 3, 4, 5, 6. Naloxone acts by competitively binding at the μ, κ and δ opiate receptors. Naloxone is highly lipophilic, so distribution to the brain is rapid. Naloxone is usually administered by the i.v. route, and this is most commonly recommended

Conclusion

Naloxone administration via nebulizer effectively and gently reversed methadone overdose in our narcotic-dependent patient. Further research needs to be done to optimize future use of naloxone by this route.

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