Jeffrey Panko NP Psychiatry · Patient education
Nalmefene
Opvee / Zurnai emergency rescue · Selincro oral international use
A guide for adults taking nalmefene.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Opvee is a single-use nasal spray; Zurnai is a single-use thigh auto-injector. Oral Selincro and clinician-administered injections have separate uses and instructions.
What it is used for
In the United States, nalmefene formulations reverse known or suspected opioid overdose. This is emergency treatment and must be followed by emergency medical care.
Selincro oral nalmefene is used in some countries to reduce drinking in selected adults with alcohol dependence. It is not a U.S.-approved alcohol treatment and does not treat alcohol withdrawal.
How it works
It blocks opioid receptors. This can restore breathing after opioid exposure, but can also trigger abrupt withdrawal in someone physically dependent on opioids.
What to expect over time
Rescue treatment works during an emergency, but breathing problems can recur. Oral alcohol treatment is reviewed over weeks alongside psychosocial support.
Taking your medication
- For suspected opioid overdose, give the available prescribed rescue device promptly and call 911. Follow its instructions and dispatcher guidance for breathing support or CPR.
- If breathing does not improve or slows again, repeat with a new device every 2–5 minutes while waiting for help. Stay with the person.
- Do not test a rescue device or reuse it. Keep enough devices available for repeat dosing.
- For oral Selincro, follow the separate prescriber plan; never use oral tablets as overdose rescue.
When to get help
Emergency symptoms. Suspected opioid overdose always requires 911. Unresponsiveness, slow or absent breathing, and blue or gray lips are emergency signs; give rescue medicine and follow dispatcher instructions.
Prompt medical advice. After recovery, arrange follow-up for overdose prevention and substance-use treatment. Oral-treatment patients should report severe confusion, hallucinations, or persistent adverse effects.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Opioid withdrawal: sweating, nausea, vomiting, cramps, agitation, or rapid pulse
- Headache or dizziness
- With oral treatment: nausea, insomnia, or transient confusion
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
After rescue, the person needs emergency assessment even if awake. Discuss replacement devices and ongoing overdose prevention afterward.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Tell your provider about opioid use, including methadone, buprenorphine, tramadol, and opioid pain or cough medicines. For oral treatment, opioid use and dependence are major contraindications.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Nalmefene interferes with opioid pain treatment. Do not try to overcome receptor blockade by taking more opioids. Tell emergency and surgical teams about oral nalmefene use.
Everyday tips
Teach household members where rescue devices are kept and how to use them.
Check expiry dates and replace used devices promptly.
Your questions answered
Is rescue medicine enough if the person wakes up?
No. Breathing can worsen again and other substances may also be involved. Stay with the person until emergency help arrives.
Can the oral tablets replace a rescue spray?
No. The formulations serve different purposes and are not interchangeable.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.