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Cited by 19Opioid Use Disorder TreatmentPoisoning and overdose treatmentsForensic Toxicology and Drug Analysis

Naloxone Dosing and Hospitalization for Nitazene Overdose: A Scoping Review

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Berger, Jonathan C., Severe, Alec D., Jalloh, Mohamed S., Manini, Alex F.·2025·Journal of Medical Toxicology
DOI 10.1007/s13181-025-01059-8
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Abstract

Introduction Nitazene compounds are high potency, synthetic opioids, recently detected in the United States illicit opioid supply. This is a scoping review to summarize the available body of literature on naloxone and hospitalization reports in response to nitazene compound overdose.Methods This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for Scoping Reviews. PubMed, ProQuest, and Google Scholar were accessed. Articles were limited to full-text peer-reviewed publications appearing in scholarly journals between January 2018 and December 2024. Total naloxone dose (in mg, primary outcome) and total length of stay (LOS, in hours, secondary outcome) were recorded.Results Of 109 articles screened, 103 were excluded (44 non-human; 35 no nitazene exposure, 9 no naloxone administered, 9 post-mortem data only, 3 non-overdose, 2 non-English, and 1 full text unavailable), leaving 6 articles included. Data were described on 19 distinct patients with nitazene compound overdose (meto-, isoto-, proto-, and eto-nitazene), all of whom had naloxone data, and 10 of whom had LOS data. Median total naloxone doses were the following: metonitazene 6.00mg; etonitazene 3.06mg; isotonitazene 3.00mg; protonitazene 1mg (p=0.4). Mean hospital LOS were the following: metonitazene 360 hours; etonitazene 122.25 hrs; isotonitazene 32.67 hrs; protonitazene 20 hrs.Conclusion This scoping review reveals a paucity of data on nitazene compound overdoses and identifies a gap in our current opioid crisis response. Most nitazene cases reviewed involved hospitalization, had high naloxone dosing, and relatively long LOS. Differences in naloxone dose and hospital LOS could underscore the unpredictable and potent nature of these substances.

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  • In clinical settings, naloxone remains an effective antidote for nitazene intoxication, consistent with its efficacy against other potent opioids.

    “in clinical settings, naloxone remains an effective antidote for nitazene intoxication, consistent with its efficacy against other potent opioids.”

    From Nitazenes: The Emergence of a Potent Synthetic Opioid Threat (2025) · cites this paper as [11]

    The Naloxone Dosing section reports nitazene overdoses reversed with naloxone, supporting its clinical use as an antidote. But it also reports four deaths among 17 cases, and the Discussion says evidence is limited and effective dosing remains uncertain. The copy does not establish a comparison of naloxone’s efficacy against nitazenes and other potent opioids. (LLM, conf=0.82)

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  • Due to high potency, slow dissociation from the MOR and prolonged effects of some active metabolites, higher or repeated doses of naloxone and, in some cases, continuous infusions may be required for complete reversal of nitazene intoxication.

    “However, due to their high potency, slow dissociation from the MOR and the prolonged effects of some active metabolites, higher or repeated doses of naloxone and, in some cases, continuous infusions may be required for complete reversal [11,42,43].”

    From Nitazenes: The Emergence of a Potent Synthetic Opioid Threat (2025) · cites this paper as [11]

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  • Many nitazene analogues are substantially more potent than morphine and, in some cases, more potent than fentanyl.

    “The potency of nitazenes is a major concern, as many analogues are substantially more potent than morphine and, in some cases, more potent than fentanyl.”

    From Nitazenes: The Emergence of a Potent Synthetic Opioid Threat (2025) · cites this paper as [11]

    The Challenges in Testing section says nitazene potency has been found to greatly exceed fentanyl’s, supporting the fentanyl comparison. Our copy does not compare nitazene analogues with morphine or establish how many analogues meet either comparison (no page number is available). (LLM, conf=0.86)

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  1. Publisher's Note Springer Nature remains neutral with regard to juris- dictional claims in published maps and institutional affiliations. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the · DOI

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Authors
Berger, J. C., Severe, A. D., Jalloh, M. S., & Manini, A. F.
Affiliations
  • Icahn School of Medicine at Mount Sinai (US)
  • Elmhurst Hospital Center (US)
Corresponding author
Berger, Jonathan C.
ORCID
Venue
Journal of Medical Toxicology
Publisher
Springer Science and Business Media LLC
Published
2025-02-04
Volume
21
Issue
2
Pages
276-283
ISSN
  • 1556-9039 (ISSN-L)
  • 1937-6995
DOI
10.1007/s13181-025-01059-8
OpenAlex
W4407126182
Cited by
19
References
21
Citations by year
2026: 7 · 2025: 12
FWCI
17.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Medical Toxicology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institutes of Health (DA048009, DA056891, HL129974)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
Keywords
synthetic opioids, opioid overdose, naloxone dosing, hospitalization, length of hospital stay, etonitazene, isotonitazene
MeSH terms
Analgesics, Opioid, Hospitalization, Humans, Naloxone, Narcotic Antagonists, Nitroparaffins, Drug Overdose

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