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Superdosagem de opioides

Última revisão: 6 Aug 2025
Última atualização: 09 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • miose
  • bradipneia
  • estado mental alterado
  • resposta dramática à naloxona
Full details

Other diagnostic factors

  • marcas de agulha recentes
  • objetos próximos associados ao uso de drogas
  • redução da motilidade gastrointestinal
  • marcas de agulha antigas nos braços ou nas pernas
  • estertores pulmonares
  • escarro róseo e espumoso
  • convulsões
  • disritmias
Full details

Risk factors

  • história de opioides prescritos
  • transtorno e dependência relacionados ao uso de opioides
  • abstinência recente em usuários crônicos
  • tomar opioides por injeção
Full details

Diagnostic tests

1st tests to order

  • tentativa terapêutica com naloxona
  • eletrocardiograma (ECG)
Full details

Tests to consider

  • radiografia torácica
  • tomografia computadorizada (TC) abdominal
  • radiografia abdominal
  • triagem de opioides na urina
  • cromatografia gasosa acoplada à espectrometria de massa
Full details

Treatment algorithm

ACUTE

sem pacotes de substância retidos

com pacotes de substância retidos

Contributors

Authors

Ruben Thanacoody, MD, FRCP, FRCP(Edin), FEAPCCT

Consultant Physician and Clinical Toxicologist

Director, National Poisons Information Service (Newcastle)

Honorary Clinical Senior Lecturer, Newcastle University

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests. RT is an author of a reference cited in this topic.

Acknowledgements

Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.

Disclosures

DO declares that he has no competing interests.

Peer reviewers

Joseph Donroe, null

Associate Professor of Medicine

Yale School of Medicine

New Haven

CO

Disclosures

JD declares that he has no competing interests.

Anne-Maree Kelley, MD, MClinEd, FACEM

Director

Joseph Epstein Centre for Emergency Medicine Research

Western Health Sunshine Hospital

St Albans

Australia

Disclosures

AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.Full text  Abstract

Dezfulian C, Orkin AM, Maron BA, et al. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021 Apr 20;143(16):e836-70.Full text  Abstract

Resuscitation Council UK. 2021 resuscitation guidelines. 2021 [internet publication].Full text

Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019 Nov-Dec;23(6):749-63.Full text  Abstract

Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Superdosagem de opioides images
  • Differentials

    • Superdosagem de gama-hidroxibutirato (GHB)/gama-butirolactona (GBL)
    • Superdosagem de clonidina/imidazolinas
    • Superdosagem de antipsicóticos
    More Differentials
  • Guidelines

    • Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department
    • 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
    More Guidelines
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