Intranasal or intramuscular naloxone Thanks to Fiona Raeburn

Intranasal or intramuscular naloxone? Thanks to Fiona Raeburn, Specialist Pharmacist in Substance Misuse, NHS Grampian

WHERE ARE WE? 8, 917 kits supplied in Edinburgh since 2011 4, 685 people at risk have received a “ 1 st supply” of estimated 9000 problem drug users Almost 1743 of these supplies were made in 1 year 2018 -19 1020 resupplies reported as “used for overdose” THAT’S A POSSIBLE 1020 lives saved in Lothian that have been reported

NASAL VS INTRAMUSCULAR NALOXONE NYXOID NASAL SPRAY PRENOXAD INTRAMUSCULAR INJECTION

NASAL VS INTRAMUSCULAR NALOXONE PRENOXAD INTRAMUSCULAR INJECTION NYXOID NASAL SPRAY Contains two nasal sprays Each spray contains one 1. 8 mg DOSE OF NALOXONE Do not prime or test – when it’s gone! Administer the contents of one spray into the nostril Switch the nostril for the next dose(s) if needed One pre-filled syringe with 5 x 0. 4 mg doses of naloxone + 2 needles Must be PRENOXAD brand of naloxone Others don’t contain needles so useless in community settings Administer in thigh or upper arm muscle

NASAL VS INTRAMUSCULAR NALOXONE FOR BOTH PRODUCTS Administer one dose every 2 – 3 minutes until either The person responds – recovery position and monitor OR The ambulance/police etc arrive and take over OR You have no naloxone left

NASAL VS INTRAMUSCULAR NALOXONE IN 2 mg IM 0. 4 mg

NASAL VS INTRAMUSCULAR NALOXONE What will this mean in practise? Intranasal and intramuscular should have similar onset of action when using equivalent doses (0. 4 mg intramuscular vs 1. 8 mg intranasal). Intranasal may not be as effective if there is a lot of mucous etc in nasal passageway At these doses intranasal concentration is likely to continue to increase in the body for longer than intramuscular POTENTIAL TO LAST LONGER POTENTIAL TO RESULT IN MORE SEVERE SYMPTOMS OF WITHDRAWAL HOWEVER Comparisons done in laboratory conditions In practise many people will give variable number of doses using pre-filled syringe – may be more than 0. 4 mg

NASAL VS INTRAMUSCULAR NALOXONE How to choose between the two products Prenoxad intramuscular injection For people who have used Prenoxad before and are happy with it – give Prenoxad For people who have not used Prenoxad offer this as the first option

NASAL VS INTRAMUSCULAR NALOXONE How to choose between the two products Nyxoid nasal spray Nyxoid might be better for Younger people – licensed from 14 years vs 16 years People who won’t take the injectable product Don’t like injections or the thought of using an injection Potentially people who use oral opioids e. g. opioid analgesics Family members Non-clinical service workers who might be less used to injecting medication People request replacement kits for other purposes e. g. used needles etc to inject drugs People who have refused naloxone in the past People who say they would prefer to try the nasal product

Naloxone preparation & administration - Nyxoid Watch Film “Nyxoid Training video” (Click Logo)

Naloxone preparation & administration - Prenoxad Click on Image 8 below for more detailed information Watch Film “Administering Prenoxad Injection” (Click Logo)