Protonitazenes and Naloxone

"Naloxone appears to be effective in treating PNZ [Protonitazene] intoxications, with most patients who received naloxone recovering completely, but the exact efficacy of naloxone and the effective dosage amounts are unknown due to the complicated nature of the currently reported intoxications. In the reviewed case reports, naloxone was administered through intranasal, intramuscular and intravenous routes [29, 30, 32]. The efficacy of naloxone in these cases cannot be properly assessed due to the coingestants, on which naloxone has no effect, such as alcohol or benzodiazepines. As the in vivo half‐life of PNZ is not known, there are insufficient data to determine whether repeat naloxone dosing is required to combat PNZ intoxications, as it is with several other opioids with long half‐life times. If they present themselves, cases concerning monointoxications with only PNZ ought to be reported to learn more about these aspects of the substance. Furthermore, the statement made by Partridge et al. [29] regarding the requirement of higher doses of naloxone for nitazene intoxications must be nuanced by noting that case reports can only retrospectively document how much naloxone was given and, as such, cannot state that the naloxone ‘was required’. To do this, further study is necessary."