In the out-of-hospital setting, larger intramuscular doses of naloxone may be used because the IM route is more rapid and reliable. What is the frequency of severe agitation following administration of a single 1.6 mg IM naloxone dose in patients with opioid toxicity in the outpatient setting?
In a recent prospective study of adult patients, severe agitation occurred in 7% of patients, which the authors conclude is uncommon. In this study, only 3 patients (1.5%) required chemical sedation following opioid reversal. More concerning, the overall rate of opioid withdrawal was 40% in this study population.
Isoardi KZ, Parker L, Harris K, Rashford S, Isbister GK. Acute Opioid Withdrawal Following Intramuscular Administration of Naloxone 1.6 mg: A Prospective Out-Of-Hospital Series. Ann Emerg Med. 2022 Aug;80(2):120-126. doi: 10.1016/j.annemergmed.2022.03.004. Epub 2022 Apr 29. PMID: 35491292.