The following is a summary of “Comparison of intranasal naloxone and intranasal nalmefene in a translational model assessing the impact of synthetic opioid overdose on respiratory depression and cardiac arrest,” published in the May 2024 issue of Psychiatry by Laffont et al.
Researchers conducted a prospective study to predict and compare outcomes of intranasal (IN) naloxone and nalmefene to reverse opioid-induced cardiac arrest, specifically fentanyl and carfentanil, using a translational model.
They used the translational model developed by Mann et al. (Clin Pharmacol Ther 2022), using published codes and confirming previous findings regarding the incidence of cardiac arrest events following intravenous doses of fentanyl and carfentanil and 2 mg dose of intramuscular (IM) naloxone in reducing these events. The model was then used to simulate the effects of IN naloxone hydrochloride (4 mg) and IN nalmefene hydrochloride (3 mg), both approved by the FDA for opioid overdose treatment. Simulations were performed to quantify the percentage of cardiac arrest events in 2000 virtual patients with and without IN antagonist treatment.
The results showed that IN nalmefene showed a significantly greater reduction in the incidence of cardiac arrest compared to IN naloxone after simulated overdose with fentanyl and carfentanil. A dose of fentanyl (1.63 mg) caused cardiac arrest in 52.1% of patients (95% CI, 47.3-56.8); IN nalmefene reduced this rate to 2.2% (1.0-3.8) compared to 19.2% (15.5-23.3) IN naloxone. Nalmefene also demonstrated substantial reductions in cardiac arrests in opioid-naïve individuals. Across dosing scenarios, 4 simultaneous doses of IN naloxone were needed to reduce the percentage of cardiac arrest to levels produced by a single dose of IN nalmefene.
Investigators concluded that the translational model of opioid overdose highlights that using IN nalmefene is more effective than IN naloxone for reducing cardiac arrest after synthetic opioid overdoses.
Source: frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1399803/abstract
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