Improvised naloxone nasal sprays lack evidence of absorption and effectFebruary 04, 2016
Naloxone hydrochloride is a medication that can reverse the effects of an opioid overdose. First responders (peers, family, police, etc.) may prefer nasal sprays to injectable naloxone, which has led to widespread use of improvised naloxone kits with atomisers for nasal delivery of the drug. On 18 November 2015, the US Food and Drug Administration (FDA) approved a nasal naloxone product to replace those improvised kits.
In a debate paper published online today by the scientific journal Addiction, top researchers at the National Addiction Centre at King's College London criticise the extensive use of improvised nasal naloxone kits without testing and without regulatory approval. Improvised nasal naloxone kits were first introduced in the early 2000s in the absence of licensed non-injectable products, and today they continue to be used in the US (where improvised kits are still in circulation in the community) and also in an increasing number of countries where nasal Narcan has not yet been approved.
The authors point out that there isn't enough information available on improvised nasal naloxone kits to warrant this level of acceptance. Improvised nasal kits consist of standard naloxone syringes (developed and licensed for injection), to which a nasal atomizer is attached. The formulation is not concentrated, as naloxone syringes are only commercially available in concentrations of up to 1mg/ml. The single pharmacokinetic study published on non-concentrate naloxone showed that only 4% of naloxone is absorbed when administered nasally. Clinical trials on improvised nasal naloxone kits are underway, but no data on levels of naloxone absorbed have been published.
Lead author Professor John Strang says, "We are attracted to nasal naloxone as a concept, but we are concerned that improvised nasal sprays have been accepted by the treatment field without the sort of testing that would be demanded if a new drug delivery route were proposed for treatment of other populations. We wouldn't accept untested improvised nasal adrenaline/epinephrine for treating emergency allergic reactions. So why are makeshift nasal naloxone kits good enough for people with opioid dependence?"
Strang also points out that we also haven't considered how reliably nasal naloxone works in opioid users whose nasal mucosa may be damaged from drug snorting, or obstructed by vomit during overdose. Ambulance-based studies indicate that between 9 and 26% of opioid overdose victims fail to respond to nasal naloxone. Strang says, "It's one thing to use nasal naloxone in a hospital or from an ambulance, where a doctor or paramedic can administer naloxone by injection if the nasal dose doesn't work. But these nasal naloxone kits, whether FDA-approved or not, are designed to help caregivers save overdose victims on the spot, so they need to be reliable. More data are needed to understand how reliably nasal naloxone reverses opioid overdose in the community. With a naloxone spray now licensed (in the U.S. only) and licensed naloxone injections available internationally, clinicians should either prescribe the long-established injection naloxone or, in the US at least, the newly-approved naloxone nasal spray. They should not prescribe untested, improvised nasal sprays for which absorption remains unknown, probably poor and likely vary variable."
Related Drug Articles:
Researchers have found a way to increase the effectiveness of a widely used cancer drug while decreasing the risk of heart-damaging side effects, according to a new study by researchers from The University of Texas Medical Branch at Galveston and Texas Tech University Health Sciences Center.
Adding a modest 2% income-based deductible for prescription drugs did not appear to deter some seniors from filling prescriptions, found a study of British Columbia's public drug plan published in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.161119.
People who have recently been found to have drug-resistant bacteria in their urine or stool samples have a greatly increased risk of developing a bloodstream infection that is also resistant to certain antibiotics, according to a study presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases.
A research team from the Virginia Tech Center for Drug Discovery has received a $431,126 two-year grant from the National Institutes of Health to make improved versions of a promising compound called MMV008138, or 8138 for short.
A new monoclonal antibody, ibalizumab appears to benefit patients with multidrug-resistant HIV, according to phase 3 research being presented at IDWeek.
Scientists have created an algorithm that can identify drug combinations to treat fungal infections that have become resistant to current drug treatments.
Areas in the US with the highest drug-overdose death rates are not always places with high drug trafficking, according to a new University of Pittsburgh Graduate School of Public Health analysis.
A new study suggests that an epilepsy drug that can be taken once a day may control seizures as well as a drug that must be taken twice a day, according to a preliminary study released today that will be presented at the American Academy of Neurology's 68th Annual Meeting in Vancouver, Canada, April 15 to 21, 2016.
The World Health Organization recommends treating malaria with artemisinin combination therapy (ACT), consisting of artemisinin and another drug.
Researchers have developed a system the size of a household fridge that can synthesize a variety of pharmaceuticals in short periods of time, including an antihistamine, an antidepressant, a common local anesthetic, and a central nervous system depressant.
Related Drug Reading:
Nursing2019 Drug Handbook (Nursing Drug Handbook)
by Lippincott (Author)
Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product.
THE #1 Drug Guide for nurses & other clinicians…always dependable, always up to date!
Look for these outstanding featuresCompletely updated nursing-focused drug monographs featuring over 3,650 generic, brand-name, and combination drugs in an easy A-to-Z format37 brand-new FDA-approved drugs in this edition, including 33 complete monographs—tabbed and... View Details
Drug Information Handbook
by Lexicomp (Author)
New book shipped from our warehouse View Details
Slow Dancing on Hard Drugs
by @Ryan_A_Bell (Author)
Ryan A Bell, a mixed-media artist, weaves past and present, reality and fiction, AI- and app-generated words into a tapestry of trance-inducing text. Slow Dancing on Hard Drugs is a groundbreaking work for a new generation of readers whose worlds blur the real and virtual, augmented and authentic. Sex and dystopias and space, oh my! Slow Dancing on Hard Drugs is an odd Ai-induced trance that skews lines between artistic vision and how we interact with technology. Ryan A Bell’s unapologetic curation of prose, haibun, and haiku are edited and intermingled with new poetry. This new partnership... View Details
Davis's Drug Guide for Nurses
by April Hazard Vallerand PhD RN FAAN (Author), Cynthia A. Sanoski BS PharmD FCCP BCPS (Author)
Davis’s Drug Guide for Nurses®, Fifteenth Edition delivers all of the information you need to administer medications safely across the lifespan—well-organized monographs for hundreds of generic and thousands of trade-name drugs.
FREE DIGITAL ACCESS
Davis’s Drug Guide for Nurses®, Sixteenth Edition delivers all of the information you need to administer medications safely across the lifespan—well-organized monographs for hundreds of generic and thousands of trade-name drugs.
FREE DIGITAL ACCESS
Mosby's 2019 Nursing Drug Reference, 32e (SKIDMORE NURSING DRUG REFERENCE)
by Linda Skidmore-Roth RN MSN NP (Author)
Put the most trusted name in nursing in your hands. Mosby’s 2019 Nursing Drug Reference is a full-color portable nursing drug handbook that makes it easy to find the most vital information on the drugs that nurses administer most frequently. More than 5,000 drugs are profiled in the text and on the free app ― including 15 new entries for drugs and drug therapies recently approved by the FDA. Plus, no other drug guide places a higher emphasis on patient safety, with Black Box Warnings for dangerous adverse reactions, Safety Alerts for situations requiring special... View Details
Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients--and Natural Ways to Restore Them
by Suzy Cohen (Author)
Unpleasant, uncomfortable, and unexplained side effects? Drug Muggers is your side effect solution.
Prescription and over-the-counter drugs help millions of people with devastat-ing diseases and chronic conditions. But in the process, these medications can also deplete the body's natural stores of vitamins, minerals, and hormones—the very nutrients you need to keep energy levels high, fend off infections, and be healthy. Pharmacist Suzy Cohen calls these medications "drug muggers," and she says it's essential to replenish what a drug mugger steals from your body in order to feel your... View Details
Drugs, Society, and Human Behavior
by Carl L Hart Dr. (Author), Charles J. Ksir (Author)
Drugs, Society and Human Behavior provides the latest information on drug use and its effects on society as well as on the individual. Trusted for more than 40 years by both instructors and students, this authoritative resource examines drugs and drug use from a variety of perspectives―behavioral, pharmacological, historical, social, legal, and clinical. The 16th edition includes the very latest information and statistics and many new timely topics and issues have been added that are sure to pique students’ interest and stimulate class discussion.
Instructors and students... View Details
Blitzed: Drugs in the Third Reich
by Norman Ohler (Author), Shaun Whiteside (Translator)
New York Times Bestseller
“[A] fascinating, engrossing, often dark history of drug use in the Third Reich.” — Washington Post
The Nazi regime preached an ideology of physical, mental, and moral purity. Yet as Norman Ohler reveals in this gripping new history, the Third Reich was saturated with drugs: cocaine, opiates, and, most of all, methamphetamines, which were consumed by everyone from factory workers to housewives to German soldiers. In fact, troops were encouraged, and in some cases ordered, to take rations of a form of crystal... View Details