Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis

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YOUSEFIFARD MAHMOUD; Vazirizadeh Mahabadi Mohammadhossein; Madani Neishaboori Arian; Rafiei Alavi Seyedeh Niloufar; AMIRI MARZIEH; BARATLOO ALIREZA; SABERIAN PEYMAN

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Journal: Frontiers in Emergency Medicine Year:2020 | Volume:4 | Issue:2 Page(s): 0-0

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Title

Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis

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Keywords

Drug Administration Routes

Emergency Medical Services

Naloxone

Opioid-Related Disorders

Substance-Related Disorders

Abstract

Context: The present systematic review and meta-analysis aims to perform an extensive search in databases to compare the efficacy of the intranasal administration of Naloxone with its intramuscular/intravenous administration in the pre-hospital management of opioid overdose. Evidence acquisition: This meta-analysis included controlled trials conducted on the efficacy of Naloxone administration in the pre-hospital management of opioid overdose. A search was carried out in electronic databases on relevant articles published by the end of 2018. After data collection, analyses were performed in STATA 14. 0 software and the efficacy and side-effects of the two administration routes of Naloxone, i. e. intranasal and intramuscular/intravenous, were compared. An overall effect size with 95% confidence interval (95% CI) was provided for each section. Results: Eventually, data from six studies were included in this meta-analysis. The success rate of the intranasal and intramuscular/intravenous administration of Naloxone in the management of opioid overdose in prehospital settings was 82. 54% (95% CI: 57. 97 to 97. 89%) and 80. 39% (95% CI: 57. 38 to 96. 04%), respectively. There was no difference between injectable (intramuscular/intravenous) Naloxone and intranasal Naloxone in the pre-hospital management of opioid overdose (Odds Ratio=1. 01; 95% CI: 0. 42 to 2. 43; P=0. 98). The onset of action of intranasal Naloxone, however, was slightly longer than injectable Naloxone (Standardized Mean Difference=0. 63; 95% CI: 0. 07 to 1. 19; P=0. 03). Additionally, the odds of needing a rescue dose was 2. 17 times higher for intranasal Naloxone than intramuscular/intravenous Naloxone (OR=2. 17; 95% CI: 1. 53 to 3. 09; P<0. 0001). The prevalence of major side-effects was non-significant for both intranasal (0. 00%) and intramuscular/intravenous (0. 05%) routes of Naloxone administration and there was no difference in the prevalence of major (OR=1. 18; 95% CI: 0. 38 to 3. 69; P=0. 777) and minor (OR=0. 64; 95% CI: 0. 17 to 2. 34; P=0. 497) side-effects between the two routes. Conclusion: The present meta-analysis demonstrated that intranasal Naloxone is as effective as injectable Naloxone in the pre-hospital management of opioid overdose complications. Consequently, intranasal Naloxone may be an appropriate alternative to injectable Naloxone.

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APA: Copy

YOUSEFIFARD, MAHMOUD, Vazirizadeh Mahabadi, Mohammadhossein, Madani Neishaboori, Arian, Rafiei Alavi, Seyedeh Niloufar, AMIRI, MARZIEH, BARATLOO, ALIREZA, & SABERIAN, PEYMAN. (2020). Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis. (FRONTIERS IN EMERGENCY MEDICINE) ADVANCED JOURNAL OF EMERGENCY MEDICINE, 4(2), 0-0. SID. https://sid.ir/paper/351151/en

Vancouver: Copy

YOUSEFIFARD MAHMOUD, Vazirizadeh Mahabadi Mohammadhossein, Madani Neishaboori Arian, Rafiei Alavi Seyedeh Niloufar, AMIRI MARZIEH, BARATLOO ALIREZA, SABERIAN PEYMAN. Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis. (FRONTIERS IN EMERGENCY MEDICINE) ADVANCED JOURNAL OF EMERGENCY MEDICINE[Internet]. 2020;4(2):0-0. Available from: https://sid.ir/paper/351151/en

IEEE: Copy

MAHMOUD YOUSEFIFARD, Mohammadhossein Vazirizadeh Mahabadi, Arian Madani Neishaboori, Seyedeh Niloufar Rafiei Alavi, MARZIEH AMIRI, ALIREZA BARATLOO, and PEYMAN SABERIAN, “Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis,” (FRONTIERS IN EMERGENCY MEDICINE) ADVANCED JOURNAL OF EMERGENCY MEDICINE, vol. 4, no. 2, pp. 0–0, 2020, [Online]. Available: https://sid.ir/paper/351151/en

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