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Modifying naloxone to reverse fentanyl-induced overdose
Journal article   Peer reviewed

Modifying naloxone to reverse fentanyl-induced overdose

Michael Voronkov, Georgiy Nikonov, Janna Ataiants, Levon Isakulyan, Cristina Stefanut, Mihai Cernea and John Abernethy
International journal of pharmaceutics, v 611, 121326
05 Jan 2022
PMID: 34848365

Abstract

Fentanyl Naloxone Overdose reversal Pharmacology
[Display omitted] Developing an effective antidote for fentanyl-induced overdose (OD) is an unmet medical need that requires both lipophilicity comparable to fentanyl and fast onset of overdose reversal. We synthesized and evaluated a bioreversible derivative of naloxone (NX-90) in silico, in vitro and in vivo to yield a robust reversal of fentanyl-induced OD in rats. All monitored reflexes along with the heart rate (HR) and respiratory rate (RR) were fully restored faster in the NX-90 groups than in naloxone groups on equimolar bases when given intranasally. In NX-90 treated rats RR over the time of observation (RR AUC) was significantly higher at all respective doses with no re-narcotization observed. Apart from the enhanced pharmacodynamics profile, NX-90 was found to have lower circulating levels of naloxone, clean profile in in vitro selectivity panels, as well as Ames and CYP450 counter screens. Finally, we demonstrated a robust release of the parent naloxone in brain matrix, as well as lower peripheral naloxone levels after NX-90 iv administration. With the demonstrated pharmacological profile superior yet congruent to naloxone we nominated NX-90 for preclinical development as an effective intranasal fentanyl antidote.

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Web of Science research areas
Pharmacology & Pharmacy
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