Narcan

Narcan (Naloxone), Opvee (Nalmefene)

Naloxone is a medication approved by the  Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as fentanyl, heroin, morphine, and oxycodone. Administered when a patient is showing signs of opioid overdose. Naloxone is a temporary treatment and its effects do not last long.

 It is critical to obtain medical intervention as soon as possible after administering/receiving naloxone.

 The medication can be given by intranasal spray (into the nose), intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection.

A practitioner should assess the need to prescribe naloxone for patients who are taking methadone or buprenorphine receiving or otherwise considered a risk for opioid overdose.

Candidates for Naloxone (Narcan) are those who:
 

• Take high doses of opioids for long-term management of chronic pain
• Receive rotating opioid medication regimens
• Have been discharged from emergency medical care following opioid poisoning or intoxication
• Take certain extended-release or long-acting opioid medication
• Those who have had a period of abstinence to include those recently released from incarceration.

Pregnant women can be safely given Naloxone (Narcan) in limited doses under the supervision of a doctor.

A doctor or pharmacist can show patients, their family members, or caregivers how to administer Naloxone (Narcan.)

Patients given an automatic injection device or nasal spray should keep the item available at all times. It is important to remember to replace medication when the expiration date passes and if exposed to temperatures below 39°F or above 104°F.

THE HISTORY OF NALOXONE / NARCAN:

 Naloxone or Narcan is a medication that is used to rapidly reverse opioid overdose. It works by binding to the same receptors in the brain that opioids bind to, thereby reversing the effects of the opioids. Here is a brief history of Naloxone (Narcan):

Discovery and Development:

• Naloxone (Narcan) was first synthesized in 1961 by Jack Fishman and Mozes J. Lewenstein. It was initially developed as part of a project to create new analgesic (pain-relieving) compounds at Endo Laboratories in New York.

Approval and Medical Use:

• Naloxone (Narcan) was approved by the U.S. Food and Drug Administration (FDA) in 1971. Its primary medical use is for the complete or partial reversal of opioid overdose, whether intentional or accidental. In early 2000 Dr. Roger Crystal of Opiant Pharmaceuticals developed the intranasal spray version of Naloxone using the name Narcan. Narcan was approved by the FDA in November of 2015. 

Mechanism of Action:

• Naloxone (Narcan)  is an opioid receptor antagonist, meaning it competes with opioids for binding to the opioid receptors in the brain. By displacing the opioids from these receptors, Naloxone (Narcan) rapidly reverses the effects of opioids, including respiratory depression, which is the main cause of death in opioid overdose.

 Administration:

• Naloxone (Narcan) can be administered intravenously, intramuscularly, or intranasally. Intranasal formulation, in particular, has been widely used in community settings and by emergency medical personnel due to its ease of use.

Distribution to First Responders:

• Over the years, there has been a growing recognition of the importance of making Naloxone (Narcan) more widely available, especially to first responders, law enforcement, and individuals who may be in a position to assist someone experiencing an opioid overdose.

Over-the-Counter Availability:

• In some States, efforts have been made to increase access to naloxone by making it available without a prescription. This is aimed at empowering friends and family members of individuals at risk of opioid overdose to administer the medication in emergency situations.

Public Health Initiatives:

• Naloxone (Narcan)  has become a key component of public health initiatives to combat the opioid crisis. Training programs have been implemented to educate individuals on how to recognize the signs of opioid overdose and administer Naloxone (Narcan) effectively.

Side effects:

A side effect of all opioid reversal drugs is that they create intense withdrawal symptoms including nausea, diarrhea, muscle cramps and anxiety. With naloxone, those symptoms might last 30 to 40 minutes.

Naloxone (Narcan) has played a crucial role in saving lives during opioid overdoses, and its availability and use continue to be an important aspect of public health efforts to address the opioid epidemic. The landscape surrounding Naloxone, including regulations and accessibility, may vary between countries and regions.

In May 2023 Opiant Pharmaceuticals received FDA approval for a stronger version of Naloxone (Narcan) nasal spray called Opvee (Nalmefene) which is 5 times stronger and acts faster than Naloxone (Narcan.)  Opvee is similar to Naloxone (Narcan), the life-saving drug that has been used for decades to quickly counter overdoses of heroin, fentanyl and prescription painkillers. Both work by blocking the effects of opioids in the brain, which can restore normal breathing and blood pressure in people who have recently overdosed. The drug will be available via prescription in early 2024 and is approved for patients 12 and older. Because fentanyl stays in the body longer than heroin and other opioids, some people may require multiple doses of Naloxone over several hours to fully reverse an overdose. Opvee achieved similar recovery results to Narcan, the leading brand of Naloxone nasal spray. “The whole aim of this was to have a medication that would last longer but also reach into the brain very rapidly,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse.