Hebenstreit Maridith R, Rodriguez Allison D, Veide Allison, Miles Talia
Veteran Affairs Indiana Healthcare System, Indianapolis.
Indiana University Health, Indianapolis.
Fed Pract. 2025 May;42(5):204-208. doi: 10.12788/fp.0591. Epub 2025 May 15.
Naloxone is the most frequently prescribed antidote for opioid overdose. More than one-third of opioid overdose reversals involved ≥ 2 doses of intranasal naloxone 4 mg. While an 8 mg intranasal product is available, there are limited recommendations for the preferred dosage. This study reviews and analyzes data to determine if there is a difference in prescribing patterns for naloxone 4 mg and naloxone 8 mg at Veteran Health Indiana (VHI).
Patients prescribed naloxone 4 mg or 8 mg at VHI between April 1, 2022, and April 1, 2023, were included. The primary endpoint was prescribing patterns between naloxone 4 mg and naloxone 8 mg. Data collected included naloxone prescriptions by month, number of patients with repeated naloxone fills, discipline of prescriber, type of clinic, and reason for receiving naloxone.
One hundred one veterans were included in the study; 53.5% of veterans received a prescription for naloxone 8 mg, 41.6% for naloxone 4 mg, and 4.9% for both doses. Pharmacists prescribed the highest number of naloxone prescriptions regardless of dose, followed by nurse practitioners and physicians. Most naloxone prescriptions were written using the Stratification Tool for Opioid Risk Management initiative and primary clinics. Naloxone prescriptions were for chronic opioid use, opioid use disorder, and substance use disorder.
The absence of well-defined guidance regarding dosing for intranasal naloxone has led to disparate prescribing practices between prescriber disciplines, types of clinics, and indications for receiving naloxone. This study highlights the need for clinical guidelines with supporting evidence and institution-specific guidance.
纳洛酮是治疗阿片类药物过量最常用的解毒剂。超过三分之一的阿片类药物过量逆转使用了≥2剂4毫克鼻内用纳洛酮。虽然有8毫克鼻内用产品，但关于首选剂量的建议有限。本研究回顾并分析数据，以确定印第安纳州退伍军人健康机构（VHI）开具4毫克纳洛酮和8毫克纳洛酮的处方模式是否存在差异。
纳入2022年4月1日至2023年4月1日期间在VHI开具4毫克或8毫克纳洛酮的患者。主要终点是4毫克纳洛酮和8毫克纳洛酮的处方模式。收集的数据包括每月的纳洛酮处方、重复开具纳洛酮的患者数量、开处方者的学科、诊所类型以及接受纳洛酮的原因。
101名退伍军人纳入研究；53.5%的退伍军人收到8毫克纳洛酮处方，41.6%收到4毫克纳洛酮处方，4.9%同时收到两种剂量的处方。无论剂量如何，药剂师开具的纳洛酮处方数量最多，其次是执业护士和医生。大多数纳洛酮处方是根据阿片类药物风险管理分层工具倡议和基层诊所开具的。纳洛酮处方用于慢性阿片类药物使用、阿片类药物使用障碍和物质使用障碍。
关于鼻内用纳洛酮剂量缺乏明确的指导，导致不同开处方学科、诊所类型以及接受纳洛酮的适应症之间的处方做法存在差异。本研究强调了需要有支持证据的临床指南和机构特定的指导。
