Effectiveness of naltrexone in the prevention of delayed respiratory arrest in
opioid-naive methadone-intoxicated patients.
Author(s): Aghabiklooei A(1), Hassanian-Moghaddam H, Zamani N, Shadnia S, Mashayekhian M,
Rahimi M, Nasouhi S, Ghoochani A.
Affiliation(s): Author information:
(1)Toxicological Research Center, Loghman-Hakim Hospital, Department of Clinical
Toxicology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences,
Kamali Avenue, South Karegar Street, Tehran 1333635445, Iran ; Department of
Forensic Medicine & Toxicology, Iran University of Medical Sciences, Tehran
1445613131, Iran.
Publication date & source: 2013, Biomed Res Int. , 2013:903172
Acute methadone toxicity is a major public health concern in Iran.
Methadone-intoxicated patients are in a great risk of recurrent or delayed
respiratory arrest despite the prescription of initial doses of naloxone. This
study aimed to evaluate the effectiveness of oral naltrexone in the management of
acute methadone overdose in opioid-naive patients and check if it could be a
substitute of continuous infusion of naloxone in maintaining adequate
ventilation. In a randomized, double-blind, placebo-controlled study, a total of
54 opioid-naive patients with acute methadone toxicity were enrolled. The
patients received either oral naltrexone or placebo capsules after awakening by
naloxone. All patients underwent close monitoring of respiration. Frequency of
respiratory depression or arrest, need for another dose of naloxone, duration of
hospital stay, and adverse outcomes compared between the two groups. The
incidence of respiratory depression was significantly less in those who had
received naltrexone. Our results show that single oral dose of naltrexone is
quite efficient in the prevention of recurrent or delayed respiratory arrest in
opioid-naive methadone-intoxicated patients. It can shorten the duration of
hospitalization and, as a consequence, decreased the risk of complications.
Further studies are warranted before the generalization of this approach to other
patient populations.
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