Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression

Anesthesiology. 2010 Jan;112(1):226-38. doi: 10.1097/ALN.0b013e3181c38c25.


Opioid treatment of pain is generally safe with 0.5% or less events from respiratory depression. However, fatalities are regularly reported. The only treatment currently available to reverse opioid respiratory depression is by naloxone infusion. The efficacy of naloxone depends on its own pharmacological characteristics and on those (including receptor kinetics) of the opioid that needs reversal. Short elimination of naloxone and biophase equilibration half-lives and rapid receptor kinetics complicates reversal of high-affinity opioids. An opioid with high receptor affinity will require greater naloxone concentrations and/or a continuous infusion before reversal sets in compared with an opioid with lower receptor affinity. The clinical approach to severe opioid-induced respiratory depression is to titrate naloxone to effect and continue treatment by continuous infusion until chances for renarcotization have diminished. New approaches to prevent opioid respiratory depression without affecting analgesia have led to the experimental application of serotinine agonists, ampakines, and the antibiotic minocycline.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Buprenorphine / adverse effects
  • Buprenorphine / therapeutic use
  • Humans
  • Minocycline / therapeutic use
  • Naloxone / adverse effects
  • Naloxone / therapeutic use
  • Narcotic Antagonists / therapeutic use*
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Respiratory Insufficiency / chemically induced*
  • Respiratory Insufficiency / drug therapy*
  • Respiratory Insufficiency / epidemiology
  • Respiratory Insufficiency / physiopathology
  • Serotonin Agents / therapeutic use


  • Narcotic Antagonists
  • Serotonin Agents
  • Naloxone
  • Buprenorphine
  • Minocycline