As ASA members spearheading the REVIVEme.com initiative, we appreciate the thorough review of naloxone’s pharmacokinetics and dynamics by Lemmen et al.1 and the focus it brings to our Journal’s readers. It is clear that further study of opioid overdose reversal of respiratory depression and prevention of cardiac arrest is warranted, and novel µ-receptor antagonists or combinations with agnostic respiratory stimulants represent promising developments.
There are three crucial takeaway points from the information presented in the review that require emphasis. First, because the Koff value for naloxone is greater than that of fentanyl, sufentanil, and carfentanil, one needs to be aware that a minimum of 4 mg naloxone should be given, that repeated doses may be needed to reverse respiratory depression, and that renarcotization can occur. Rescuers should always be instructed not to leave a victim unattended after giving naloxone even if breathing and consciousness are restored. It...
