Opvee (nalmefene), is an intranasal opioid antagonist used for opioid overdose and was approved by the FDA in 2023. This approval provided another tool to aid in combating the opioid crisis. There are currently two medications, Opvee and Narcan (naloxone), that can reverse acute opioid overdose. These are both brand-name medications for opioid antagonists that are administered intranasally. Narcan was approved by the FDA in 2015. In this article we will provide a comparison of Opvee versus Narcan and why you might choose one over the other.
Administration and Dosing
Narcan is packaged as two single-use 4 mg nasal spray devices. The device’s nozzle should be inserted into either nostril of the patient. Then the plunger should be pushed to expel one dose into the chosen nostril. If the patient appears to be sedated 2-3 minutes after the initial dose, it is okay to administer a second dose. It is safe to administer doses of Narcan every 2-3 minutes until healthcare professionals can help the patient.
Opvee’s packaging and administration are similar to Narcan. Opvee comes packaged as two 2.7 mg nasal spray canisters. The administration is similar to Narcan, the nozzle should be inserted into one of the patient’s nostrils and then the plunger pushed to release the medication. The administration directions on the Opvee box state that 2-5 minutes should pass before another dose is given if needed.
Pharmacokinetics – Opvee Versus Narcan
The package insert for Opvee states that after a 2.7 mg dose of the medication in healthy adult patients, the elimination half-life was 11.4 hours, significantly longer than the elimination half-life for Narcan. This means a patient may require fewer doses of Opvee compared to Narcan. Prolonged withdrawal symptoms are possible with Opvee which may be challenging to navigate for patients and healthcare professionals when they are in the recovery phase. The elimination half-life of Narcan ranges from 1.3 to 2.7 hours. Some opioids persist in the body for longer than this amount of time, which is why it is critical to stay with the patient until help arrives and administer subsequent Narcan doses.
The onset of action is critical for opioid antagonists. Data shows a little more variability in Narcan’s onset of action compared to Opvee. Narcan’s onset has been reported to range from 3-17 minutes while Opvee’s onset ranges from 2.5-5 minutes. A study published in ACCP’s Journal of Clinical Pharmacology compared the use of Narcan versus Opvee in healthy volunteers who experienced respiratory depression from remifentanil, a synthetic opioid. The primary endpoint of this study was to evaluate breathing 5 minutes after the administration of the antidote. Opvee was found to improve breathing nearly two times better than Narcan did at the 5-minute mark. It took Narcan almost 20 minutes to achieve the same amount of improvement in respiratory rate.
Cost
Opvee is only available with a prescription from a healthcare provider. The cost of Opvee will vary depending on insurance coverage and pharmacy. Typically prices are roughly $50 per dose. Narcan can be purchased over the counter or sometimes free with the help of public service organizations. Narcan has similar retail pricing for the pack of two nasal spray devices.
Advantages and Disadvantages Comparison
There are advantages and disadvantages to each of these medications. The biggest advantage of Opvee is the possible improvement in respiratory depression and quicker onset. The longer half-life may be a negative as patients may experience withdrawal symptoms for a significantly longer period of time. Opvee is not readily available to the public and requires a prescription to obtain. Narcan is widely available and even free in many areas and there is an abundance of data about the medication since it has been on the market for many years. However, some evidence may indicate that naloxone may have a slightly longer onset and may be less effective against synthetic opioids which are now responsible for the majority of overdose fatalities today.
Opioid overdose is a critical issue across the United States and has been for many years. It is important that medications such Opvee and Narcan are discussed openly and accessible to the public to decrease the amount of deaths that occur from overdoses. While these two medications are strikingly similar, it is a good thing to have a variety of options for the reversal of opioid overdose. We hope this comparison of Opvee versus Narcan has been helpful!
This article was written by Carly McDonald, PharmD Candidate in collaboration with Eric Christianson, PharmD, BCPS, BCGP
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Ellison, M., Hutton, E., Webster, L., & Skolnick, P. (2024). Reversal of Opioid-Induced Respiratory Depression in Healthy Volunteers: Comparison of Intranasal Nalmefene and Intranasal Naloxone. Journal of clinical pharmacology, 64(7), 828–839. https://doi.org/10.1002/jcph.2421
Nalmefene. IBM Micromedex® Drug Interaction Checking (electronic version). IBM Watson Health, Greenwood Village, Colorado, USA. Available at: Micromedex – Nalmefene (accessed: September 4, 2024).
Naloxone Hydrochloride. IBM Micromedex® Drug Interaction Checking (electronic version). IBM Watson Health, Greenwood Village, Colorado, USA. Available at:Micromedex-Naloxone Hydrochloride (accessed: September 4, 2024).
NIDA. 2024, August 21.Drug Overdose Deaths: Facts and Figures. Retrieved from https://nida.nih.gov/research-topics/trends-statistics/overdose on 2024,September 4.
Narcan®, Naloxone HCL – nasal spray. Emergent Drug Devices INC., Plymouth Meeting, PA 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.Narcan Accessed: September 4, 2024.
Narcan. Narcan Nasal Spray Education. Emergent Drug Devices INC. Plymouth Meeting, PA.
https://narcan.com/. Accessed September 4, 2024.
Opvee®, Nalmefene HCL – nasal spray. Indivior INC., Chesterfield, VA 2023. https://dailymed.nlm.nih.gov/dailymed/druIndivior Inc.gInfo.Opvee. Accessed: September 4, 2024.
Opvee. What is Opvee? Indivior Inc. UK Limited. https://opvee.com/what-is-opvee/. Accessed September 4, 2024.
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