Patterns of naloxone use in hospitalized patients

ABSTRACT

Objectives: Naloxone is indicated for reversal of opioid-induced respiratory depression. The objective of this study is to evaluate patterns of naloxone use in hospitalized patients.

Methods: Retrospective chart review at the University of California, San Diego Health. Subjects included adults ≥18 years old who were admitted to and received naloxone in the medical-surgical, telemetry, intermediate care, or obstetrics/gynecology units from May 1^st, 2014 to April 30^th, 2015. The primary endpoint was to determine the percentage of naloxone administrations that resulted in an improvement in sedation. Secondary endpoints included the percentage of naloxone administrations that reversed respiratory depression and any association of naloxone use with opioid routes of administration, other concomitant central nervous system depressants, or disease states. Data were analyzed using descriptive and contingency statistics.

Results: 124 episodes of naloxone were identified during the study period. 62% of naloxone administrations resulted in an improved level of consciousness. In contrast to this, only 30 (24.2%) episodes of naloxone administration met the criteria for respiratory depression. Of these 30 episodes, naloxone reversed respiratory depression in 25 (83.3%) of them. The most frequent opioid routes of administration were short-acting oral (53.2%) and IV opioids (44.4%). Of the concomitant medications, gabapentin (28.2%) was the most frequently associated sedating medication.

Conclusion: In our study, naloxone was more often used for reversal of sedation than for respiratory depression. Gabapentin may pose a risk factor for oversedation when combined with opioids, leading to increased naloxone use. Further studies are needed to explore these patterns.

KEYWORDS:

• Naloxone
• opioid analgesics
• respiratory depression
• Opioid-related sedation
• POSS

Acknowledgments

The authors would like to give special thanks to Dmitri Lerner, Pharm.D., Edmund Caparelli, Pharm.D., and Shobha Khan for their support and guidance in this project.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.