Opioid Antagonists in Pediatric Care
Core Concepts
- Competitive antagonists at opioid receptors
- Essential in opioid overdose management
- Varying durations of action
- Critical role in emergency medicine
Clinical Indications
- Acute opioid overdose
- Respiratory depression from therapeutic opioids
- Reversal of opioid-induced side effects
- Prevention of opioid dependence
Naloxone (Narcan)
Pharmacological Properties
- Competitive μ-opioid receptor antagonist
- Onset: 1-2 minutes (IV/IM)
- Duration: 20-90 minutes
- Half-life: 30-80 minutes
Clinical Applications
Emergency Indications
- Acute opioid overdose
- Respiratory depression
- Severe CNS depression
- Diagnostic tool in suspected overdose
Administration Routes & Dosing
Emergency Dosing
- IV/IM/SC: 0.01-0.1 mg/kg/dose
- Initial dose: 0.4-2 mg
- Repeat every 2-3 minutes if needed
- Maximum single dose: 2 mg
Intranasal Administration
- 2-4 mg per nostril
- May repeat after 2-3 minutes
- Preferred route for first responders
Monitoring Parameters
- Respiratory rate and effort
- Oxygen saturation
- Level of consciousness
- Vital signs
- Withdrawal symptoms
Naltrexone
Pharmacological Properties
- Long-acting opioid antagonist
- Duration: 24-72 hours
- Also blocks endorphin effects
- High first-pass metabolism
Clinical Applications
- Opioid dependence prevention
- Alcohol dependence treatment
- Self-injurious behaviors
- Eating disorders (off-label)
Dosing Guidelines
Oral Administration
- Initial: 0.5 mg/kg/day
- Maintenance: 1-2 mg/kg/day
- Maximum: 50 mg/day
- Frequency: Once daily or divided doses
Monitoring Requirements
- Liver function tests
- Compliance assessment
- Behavioral changes
- Side effect profile
Nalmefene
Characteristics
- Longer duration than naloxone
- Similar efficacy to naloxone
- Less hepatic metabolism
Clinical Use
- Opioid overdose reversal
- Post-operative opioid reversal
- Limited pediatric data available
Dosing Considerations
- IV: 0.25 mcg/kg/dose
- Titrate to effect
- Maximum single dose: 1 mg
Emergency Protocols
Assessment Algorithm
- Recognition of opioid toxicity
- Initial stabilization
- Appropriate antagonist selection
- Route of administration choice
Response Monitoring
- Immediate response assessment
- Duration of monitoring needed
- Criteria for additional doses
- Transfer of care protocols
Community Response Programs
- School-based protocols
- First responder training
- Family education
- Take-home naloxone programs
Special Considerations
Risk Assessment
- Patient risk factors
- Environmental risks
- Access to emergency care
- Support system evaluation
Withdrawal Management
- Recognition of precipitated withdrawal
- Age-specific symptoms
- Supportive care measures
- Follow-up planning
Documentation Requirements
- Indication for use
- Response to intervention
- Adverse effects
- Follow-up plans
Patient Education
- Recognition of overdose
- Proper administration technique
- Storage requirements
- Emergency contact information
Further Reading
