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Naloxone in CSCI Opioid Antagonism Error — SCE Palliative Medicine MCQ

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ModerateSyringe Driver & Drug CompatibilityNaloxone in CSCI Opioid Antagonism ErrorSCE Palliative Medicine

A patient receiving a CSCI with diamorphine 60 mg, midazolam 20 mg, and glycopyrronium 1.2 mg/24 hr develops severe opioid-induced constipation. The team proposes adding SC naloxone to the syringe driver. Is this appropriate?

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Correct answer: A — No — parenteral naloxone will antagonise opioid receptors systemically, including those mediating analgesia; it cannot selectively target gut receptors when given alongside an opioid

Option A is correct. Parenteral naloxone will reverse the analgesic effect of diamorphine and is not gut‑selective. NICE advice (TA651) supports using PAMORAs such as subcutaneous methylnaltrexone for opioid-induced constipation when laxatives are insufficient ([nice.org.uk](https://www.nice.org.uk/guidance/ta651/chapter/3-Committee-discussion?utm_source=openai)). NICE evidence update also notes that naloxone is not advised for this indication when given parenterally ([nice.org.uk](https://www.nice.org.uk/guidance/cg140/evidence/evidence-update-pdf-186447709?utm_source=openai)). Option C is false—naloxone antagonises opioids. Option B is incorrect—there is pharmacological contraindication to mixing naloxone with opioids in CSCI. Option E is a misconception: there is no sub‑analgesic dose of parenteral naloxone that spares analgesia. Option D falsely assumes selective enteric action, which is only achievable via oral naloxone due to first‑pass metabolism, not parenteral.

Reference: NICE TA651 (Naldemedine for treating opioid‑induced constipation, 2020), NICE Evidence Update CG140 (Opioids in palliative care, 2014), https://www.nice.org.uk/guidance/ta651/chapter/3-Committee-discussion