Opioid overdose A<unk>  kit as distributed in British Columbia, Canada<unk>  is useful in treating both acute opioid overdose and respiratory or mental depression due to opioids. Whether it is useful in those in cardiac arrest due to an opioid overdose is unclear. It is included as a part of emergency overdose response kits distributed to heroin and other opioid drug users, and to emergency responders. This has been shown to reduce rates of deaths due to overdose. A prescription for<unk>  is recommended if a person is on a high dose of opioid (>100 mg of morphine equivalence/day), is prescribed any dose of opioid accompanied by a benzodiazepine, or is suspected or known to use opioids<unk> onmedically. Prescribing<unk>  should be accompanied by standard education that includes preventing, identifying, and responding to an overdose; rescue breathing; and calling emergency services. Distribution of<unk>  to individuals likely to encounter people who overdose is part of the harm reduction initiatives that have spread throughout the US and the world. This approach to dealing with substance use disorder is to treat it as a medical problem and focusing efforts on reducing the harm produced directly (e.g., overdose) and indirectly (exposure to infectious disease). Clonidine overdose<unk>  can also be used as an antidote in overdose of clonidine, a medication that lowers blood pressure. Clonidine overdoses are of special relevance for children, in whom even small doses can cause significant harm. However, there is controversy regarding<unk> 's efficacy in treating the symptoms of clonidine overdose,<unk> amely slow heart rate, low blood pressure, and confusion/somnolence. Case reports that used doses of 0.1 mg/kg (maximum of 2 mg/dose) repeated every 1–2 minutes (10 mg total dose) have shown inconsistent benefit. As the doses used throughout the literature vary, it is difficult to form a conclusion regarding the benefit of<unk>  in this setting. The mechanism for<unk> 's proposed benefit in clonidine overdose is unclear, but it has been suggested that endogenous opioid receptors mediate the sympathetic<unk> ervous system in the brain and elsewhere in the body. Some poison control centers recommend<unk>  in the setting of clonidine overdose, including intravenous bolus doses of up to 10 mg<unk> . Preventing recreational opioid use<unk>  is poorly absorbed when taken by mouth, so it is commonly combined with a<unk> umber of oral opioid preparations, including buprenorphine and pentazocine, so that when taken by mouth, only the opioid has an effect. However, if the opioid and<unk>  combination is injected, the<unk>  blocks the effect of the opioid. This combination is used in an effort to prevent<unk> on-medical use. Other uses In people with shock, including septic, cardiogenic, hemorrhagic, or spinal shock, those who received<unk>  had improved blood flow. The importance of this is unclear.<unk>  is also experimentally used in the treatment for congenital insensitivity to pain with anhidrosis, an extremely rare disorder that renders one unable to feel pain or differentiate temperatures.<unk>  can also be used to treat itchiness brought on by opioid use, as well as opioid-induced constipation. Special populations Pregnancy and breastfeeding<unk>  is pregnancy category B or C in the United States. Studies in rodents given a daily maximum dose of 10 mg<unk>  showed<unk> o harmful effects to the fetus, although human studies are lacking and the drug does cross the placenta, which may lead to the precipitation of withdrawal in the fetus. In this setting, further research is<unk> eeded before safety can be assured, so<unk>  should be used during pregnancy only if it is a medical<unk> ecessity. Whether<unk>  is excreted in breast milk is unknown, however, it is<unk> ot orally bioavailable and therefore is unlikely to affect a breastfeeding infant. Children<unk>  can be used on infants who were exposed to intrauterine opiates administered to mothers during delivery. However, there is insufficient evidence for the use of<unk>  to lower cardiorespiratory and<unk> eurological depression in these infants. Infants exposed to high concentrations of opiates during pregnancy may have CNS damage in the setting of perinatal asphyxia.<unk>  has been studied to improve outcomes in this population, however the evidence is currently weak. Intravenous, intramuscular, or subcutaneous administration of<unk>  can be given to children and<unk> eonates to reverse opiate effects. The American Academy of Pediatrics recommends only intravenous administration as the other two forms can cause unpredictable absorption. After a dose is given, the child should be monitored for at least 24 hours. For children with low blood pressure due to septic shock,<unk>  safety and effectiveness are<unk> ot established. Geriatric use For patients 65 years and older, it is unclear if there is a difference in response. However, older people often have decreased liver and kidney function that may lead to an increased level of<unk>  in their body.
Naloxone
Esketamine
Eptazocine
Pentazocine
Flumazenil
Nalorphine
Ephedrine
Alfentanil