Weaver Landon, Palombi Laura, Bastianelli Karen M S
1 CentraCare Health-St Cloud, University of Minnesota Ambulatory Care Residency, St Cloud, MN, USA.
2 Department of Pharmacy Practice and Pharmaceutical Science, University of Minnesota College of Pharmacy, Duluth, MN, USA.
J Pharm Pract. 2018 Feb;31(1):91-98. doi: 10.1177/0897190017702304. Epub 2017 Apr 12.
Fatalities from opioid overdose have risen by 117% over the past 10 years. Increasing access to the opioid antagonist, naloxone can combat this trend and saves lives. This study investigates the various routes of naloxone administration for opioid reversal in the prehospital setting.
PubMed, Ovid, and Google Scholar were searched for references that included the words naloxone and prehospital. Inclusion criteria were peer reviewed publications after 1995, English language, studies conducted in an outpatient setting, and intramuscular, intranasal, intravenous, or subcutaneous formulations; exclusion criteria were review articles or editorials.
8 articles met the inclusion criteria: intramuscular, intranasal, intravenous, and subcutaneous dosage forms of naloxone were analyzed to compare their time to administration, time to efficacy, financial impact, administrator safety, and administrator preference.
There is little consensus on the optimal route of naloxone administration in the prehospital setting. Little training is required for proper administration of the intramuscular auto-injector; however, the high price of this device is a barrier to access. Intranasal naloxone appears to be the optimal dosage form when considering cost, effectiveness, and administrator safety. Pharmacists must be aware of trends in naloxone use, dosage forms, and administration when caring for patients and their communities.
在过去10年中，阿片类药物过量致死人数上升了117%。增加阿片类拮抗剂纳洛酮的可及性能够对抗这一趋势并挽救生命。本研究调查了在院前环境中用于逆转阿片类药物作用的纳洛酮的各种给药途径。
在PubMed、Ovid和谷歌学术中检索包含纳洛酮和院前等关键词的参考文献。纳入标准为1995年之后的同行评审出版物、英文、在门诊环境中开展的研究以及肌内、鼻内、静脉内或皮下制剂；排除标准为综述文章或社论。
8篇文章符合纳入标准：对纳洛酮的肌内、鼻内、静脉内和皮下剂型进行了分析，以比较其给药时间、起效时间、经济影响、给药者安全性和给药者偏好。
对于院前环境中纳洛酮的最佳给药途径，目前几乎没有共识。正确使用肌内自动注射器所需的培训很少；然而，该设备的高昂价格是获取的一个障碍。考虑到成本、有效性和给药者安全性，鼻内纳洛酮似乎是最佳剂型。药剂师在照顾患者及其社区时必须了解纳洛酮的使用趋势、剂型和给药方式。
