A naloxone nasal spray is now available for the emergency treatment of known or suspected opioid overdose. Nyxoid® is a single-dose nasal spray containing 1.8mg of naloxone in a 0.1mL solution. Naloxone is an opioid antagonist that can reverse the respiratory and central nervous system depression produced by opioid agonists.
The intranasal route is an attractive one for naloxone. It is rapidly absorbed, allows administration by non-healthcare professionals in emergencies, and avoids issues concerning needlestick injuries and potentially poor intravenous access. However, Nyxoid® is not intended to be a substitute for emergency medical care and does not replace intravenous injection.
The mean half-life of naloxone following intranasal administration is 1.4 hours, considerably less than many opioids. Therefore, repeat doses may be required. In addition, standard naloxone doses may not completely reverse the respiratory depression produced by partial agonists such as buprenorphine. A naloxone infusion may be necessary after the initial intranasal dose, particularly if a long-acting opioid or slow-release formulation is implicated in the overdose event.
Nyxoid® is a Schedule 3 medication and may, therefore, be purchased without a prescription. It is recommended to be carried by people at risk of, or likely to witness opioid overdose events. The indications, instructions for use and requirement for additional emergency medical care must be clearly explained to any person who may need to administer this product. The Penington Institute provides educational materials appropriate for non-healthcare professionals.
- Nyxoid® Nasal Spray (naloxone hydrochloride dihydrate) Australian approved product information. Mundipharma: Sydney. Approved September 2018.
- Toxicology and Wilderness Expert Group. Therapeutic Guidelines: Toxicology and Wilderness. Version 2. Melbourne: Therapeutic Guidelines; 2012.