Opioid Antagonistlerinin Klinik Önemi ve Uygulama Yolları

Yıl 2019, Cilt: 2 Sayı: 1, 34 - 38, 31.03.2019

Arzu Denizbaşı Altınok , Çiğdem Özpolat , Özge Onur

Öz

Opioid antagonistleri yalnız kimyasal ve farmakolojik özellikler olarak değil aynı zamanda klinik kullanımdaki etkinleri anlamında da eşsiz bir ilaç grubudur. Bu sınıf içinde özellikle Nalokson yaygın olarak kardiyopulmoner arrest vakalarında opioid ile indüklenen solunum depresyonunu geriye döndürmek için kullanılmaktadır. Kanıta dayalı tıpta Nalokson uygulamaları önemli yer tutar. Klinik etkinliğini ve populeritesi sonucu Naloksonun farklı ilaç formulasyonları geliştirilmiş ve farklı Nalokson uygulamaları çalışılmıştır. Nalokson intramüsküler, intranazal, subkutan, nebülize veya endotrakeal verilebilen bir ilaçtır. Uygun doz ve konsantrasyonlar ilacın verilme yoluna göre farklılık gösterir. Bu derleme en son indikasyonlar ile opioid antagonistlerinin hastane içi veya dışındaki kullanımlarını özetlemek için yazılmıştır.

Anahtar Kelimeler

Opioid Antagonist, Nalokson, Resusitasyon

Clinical Importance and Application Paths of Opioid Antagonists

Öz

Opioid antagonists are a unique class of drugs in terms of not only chemical and pharmacological properties but also efficiency in clinical practice. This class, namely Naloxone, is used widely to revert opioid induced respiratory depression in cardiopulmonary arrest cases. In evidence based medicine Naloxone administration is an important management. As a result of clinical effectiveness and popularity, different drug formulations of Naloxone have been developed and different Naloxone administrations have been studied. Naloxone is a drug that can be administered via intramuscular, intranasal, subcutaneous, inhalation or endotracheal routes. Appropriate dosing and concentration vary according to the route of administration. This review is written to summarize the use of opioid antagonists in in or out of hospital settings with recent indications.

Anahtar Kelimeler

Opioid Antagonist, Naloxone, Resuscitation

Kaynakça

• 1. Goodman AJ, Le Bourdonnec B, Dolle RE. Mu opioid receptor antagonists: recent developments. Chem Med Chem. 2007, 2(11):1552–70.
• 2. Straus MM, Ghitza UE, Tai B. Preventing deaths from rising opioid overdose in the US. Subst Abuse Rehab. 2013, 4: 65-72.
• 3. Lucyk S, Nelson LS. Opioid receptor antagonists. Ed. Brent et al. Critical Care Toxicology. DOI 10.1007/978-3-319-17900-1-62. 2907-11.
• 4. Levy JH, Brister NW, Shearin A, Ziegler J, et al. Wheal and flare responses to opioids in humans. Anesthesiology. 1989;70(5):756–60.
• 5. Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain. 1988;33(2):149–60.
• 6. Mills CA, Flacke JW, Miller JD, Davis LJ, et al. Cardiovascular effects of fentanyl reversal by naloxone at varying arterial carbon dioxide tensions in dogs. Anesth Analg. 1988;67(8):730–6.
• 7. Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012;367(2):146–55.
• 8. Goldfrank L, Weisman RS, Errick JK, Lo MW. A dosing nomogram for continuous infusion intravenous naloxone. Ann Emerg Med. 1986;15(5):566–70.
• 9. Kienbaum P, Thurauf N, Michel MC, Scherbaum N, et al. Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. Anesthesiology. 1998;88(5):1154–61.
• 10. Tenenbein M. Continuous naloxone infusion for opiate poisoning in infancy. J Pediatr. 1984;105(4):645–8. 9. Buchanan JF, Brown CR. ‘Designer drugs’. A problem in clinical toxicology. Med Toxicol Adverse Drug Exp. 1988;3(1):1–17.
• 11. Kienbaum P, Thurauf N, Michel MC, Scherbaum N, et al. Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. Anesthesiology. 1998;88(5):1154–61.
• 12. Kienbaum P, Heuter T, Michel MC, Scherbaum N, et al. Sympathetic neural activation evoked by mu-receptor blockade in patients addicted to opioids is abolished by intravenous clonidine. Anesthesiology. 2002;96(2):346–51.
• 13. Nelson LS, Howland MA. Opioid antagonists. In: Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR, editors. Goldfrank’s toxicological emergencies. 10th ed. New York: McGraw-Hill; 2015. p. 510–5.
• 14. Elzey MJ, Fudin , Edwards ES. Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems. (2016): Expert Opinion on Drug Delivery, DOI: 10.1080/17425247.2017.1230097http://dx.doi.org/10.1080/17425247.2017.1230097
• 15. Center for Drug Evaluation and Research. Summary review for regulatory action: Evzio. 2014 [cited 2016 May 25]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/205787Orig1s000SumR.pdf FDA review of the approved naloxone auto-injector.
• 16. Center for Drug Evaluation and Research. Summary review for regulatoryaction: Narcan. 2015 [cited 2016 May 25]. Available from: http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/UCM480092.pdf. FDA review of the approved naloxone nasal spray.
• 17. Barton ED, Ramos J, Colwell C, et al. Intranasal administration of naloxone by paramedics. Prehosp Emerg Care. 2002;6:54–58.
• 18. Barton ED, Colwell CB, Wolfe T, et al. Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting. J Emerg Med. 2005;29:265–271.
• 19. Kelly A-M, Kerr D, Dietze P, et al. Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose. Med J Aust. 2005;182:24–27.
• 20. Kerr D, Kelly A-M, Dietze P, et al. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction. 2009;104:2067–2074
• 21. Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23): 631-635 https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-10-special-circumstances-of-resuscitation/highlights-introduction/highlights/