Rapid systemic uptake of naloxone after intranasal administration in children

Abstract

Naloxone has a high affinity for the µ-opioid receptor and acts as a competitive antagonist thus reversing the effects of opioids. Naloxone is often administrated intravenously but there is a growing interest in the intranasal route in treating patients with opioid overdose, and in reversing effects after therapeutic use of opioids. As administration is painless and no intravenous access is needed, the intranasal route is especially useful in children. The aim of this study was to investigate the uptake of naloxone 0,4 mg/mL during the first 20 minutes after administration as a nasal spray in a pediatric population, with special focus on the time to achieve maximum plasma concentration. Twenty children, 6 months to 10 years, were included in the study. The Naloxone dose administered was 20 µg/kg, maximum 0.4 mg, divided into repeated doses of 0.1 mL in each nostril. Venous blood samples were collected at 5, 10, and 20 minutes after the end of administration. All patients had quantifiable concentrations of naloxone in venous blood at 5 minutes and within 20 minutes peak concentration had been reached in more than half of the children. At 20 minutes after intranasal administration the plasma naloxone concentrations were within the range of 2 to 6 nanogram/mL. This study confirms the clinical experience that the rapid effect of naloxone after intranasal administration in children was reflected in rapid systemic uptake to achieve higher peak plasma concentrations than previously reported in adults.