Nalmefene
Class: Opiate Antagonists
- Antidotes
VA Class: CN102
Chemical Name: (5α)-17-(Cyclopropylmethyl)-4,5-epoxy-6-methylene-morphinan-3,14-diol hydrochloride
Molecular Formula: C21H25NO3•HCl
CAS Number: 58895-64-0
Brands: Revex
Introduction
Synthetic opiate antagonist.
Uses for Nalmefene
Postoperative Opiate Depression
Treatment of opiate-induced depression, including respiratory depression, caused by natural and synthetic opiates.
Opiate Overdosage
Management of known or suspected opiate overdosage.
Nalmefene Dosage and Administration
Administration
Principally administered by IV injection; can be administered by IM or sub-Q injection if venous access cannot be established.
For reversal of postoperative opiate depression, administer blue-labeled commercially available injection containing 100 mcg/mL nalmefene.
For management of known or suspected opiate overdose, administer green-labeled commercially available injection containing 1 mg/mL nalmefene.
Proper steps should be taken to prevent use of incorrect concentration of injection.
IV Administration
Administer as an IV bolus.
Dilution
When used for treatment of postoperative opiate-induced depression in patients with increased cardiovascular risk, it may be desirable to dilute to a final ratio of 1:1 in 0.9% sodium chloride injection or sterile water for injection. (See Cardiovascular Disease under Cautions.)
Dosage
Available as nalmefene hydrochloride; dosage expressed in terms of nalmefene.
Titrate dosage to reverse opiate-induced effects; when adequate opiate reversal has been established, additional doses of nalmefene are not required and may cause unwanted reversal of analgesia or precipitate withdrawal.
Adults
Postoperative Opiate Depression
IV
Initially, 0.25 mcg/kg given at 2- to 5-minute intervals until the desired response is obtained.
Patient Weight | Initial Dosage (0.25 mcg/kg) | Volume of Nalmefene 100 mcg/mL Solution (Blue-label) to Administer |
|---|---|---|
50 kg | 12.5 mcg | 0.125 mL |
60 kg | 15 mcg | 0.15 mL |
70 kg | 17.5 mcg | 0.175 mL |
80 kg | 20 mcg | 0.2 mL |
90 kg | 22.5 mcg | 0.225 mL |
100 kg | 25 mcg | 0.25 mL |
Cumulative total dosage >1 mcg/kg does not provide additional therapeutic effect.
Patients at increased cardiovascular risk: Initially, 0.1 mcg/kg given at 2- to 5- minute intervals until desired response is obtained.
Opiate Overdosage
IV
Opiate naive patients: Initially, 7.14 mcg/kg (0.5 mg/70 kg), followe..
