Buprenorphine is relatively resistant to reversal by naloxone. We tested the effect of various doses and infusion schemes of naloxone on buprenorphineinduced respiratory depression and compared the data with naloxone-reversal of morphine and alfentanil-induced respiratory depression. Both morphine and alfentanil were easily reversed by low doses of naloxone (0.4 mg). Increasing doses of naloxone caused a bell-shaped reversal curve of buprenorphine with maximal reversal at naloxone doses between 2 and 4 mg. However, reversal was short-lived. The bell-shaped reversal curve may be related to the existence of two μ-opioid receptor subtypes, one mediating the agonist effects of opioids at low dose, the other mediating antagonistic effects at high dose.
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Sarton, E., Teppema, L., Dahan, A. (2008). Naloxone Reversal of Opioid-Induced Respiratory Depression with Special Emphasis on the Partial Agonist/Antagonist Buprenorphine. In: Poulin, M.J., Wilson, R.J.A. (eds) Integration in Respiratory Control. Advances in Experimental Medicine and Biology, vol 605. Springer, New York, NY. https://doi.org/10.1007/978-0-387-73693-8_85
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