|Comparison of Two Naltrexone Regimens in the Maintenance Therapy of Acute Methadone Overdose in Opioid-Naïve Patients;a Randomized Controlled Trial|
|Ali Ostadi1,2, Nasim Zamani2,3, Hossein Hassanian-Moghaddam2,3, Navid Khosravi2, Shahin Shadnia2,3|
|1Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
2Toxicological Research Center, Loghman Hakim Hospital, ShahidBeheshti University of Medical Sciences, Tehran, Iran
3Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
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Keywords : Intoxication, Methadone, Naltrexone, Overdose, Opioid-naïve
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Objectives: Substituting antidotes with longer half-lives may decrease the danger of unobserved respiratory depression in opioid overdose. We compared two different doses of naltrexone (50 mg versus 100 mg) in the maintenance therapy of opioid-naïve methadone-overdosed patients.
Materials and Methods: In a triple-blind study, 70 opioid-naïve methadone-intoxicated patients were prospectively included. The patients were treated by naloxone and then consecutively assigned into A or B groups receiving 100- and 50-mg naltrexone capsules, respectively. The patients were followed for 48 hours in the hospital. After discharge, they were re-evaluated by a phone call follow-up. They were finally compared regarding re-development of the toxicity signs and symptoms, need for re-administration of naloxone, and final outcome.
A total of 70 patients with mean age of 26±9 years were evaluated (35 in each group). Only diastolic blood pressure, serum bicarbonate, and base excess were significantly different between the groups.
Results: During hospitalization, one patient in group A experienced apnea while none in the group B had such experience (P>0.05). In follow-up evaluations and after hospital discharge, mean venous blood gas parameters were similar between the two groups. Hospitalization period was also similar (all Ps were greater than 0.05).
Conclusion: Two different 50-mg and 100-mg regimens of naltrexone have the same efficacy in preventing apnea and respiratory depression in methadone-intoxicated opioid-naïve patients. The 50-mg dose is therefore the superior regimen recommended for this purpose.
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