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What are the risks of naloxone during an opioid overdose when the person has underlying poorly controlled moderate-severe hypertension? IE was the opiate dependency somewhat controlling the blood pressure & sudden withdrawal then no opiates/no high blood pressure meds causes a problem?

You've gotten great responses here, but this post reminds me of something I try to teach (for others reading this)--the purpose of naloxone in an OD situation is NOT to wake the patient up; it's to keep them breathing. Much better to give small doses and titrate, apart from the increased amount of monitoring and rechecking it requires.

Just from a quick search on wiki to confirm what I was thinking. “If naloxone is administered in the absence of concomitant opioid use, no functional pharmacological activity occurs, except the inability of the body to combat pain naturally. In contrast to direct opiate agonists, which elicit opiate withdrawal symptoms when discontinued in opiate-tolerant people, no evidence indicates the development of tolerance or dependence on naloxone. The mechanism of action is not completely understood, but studies suggest it functions to produce withdrawal symptoms by competing for opioid receptors within the brain (a competitive antagonist, not a direct agonist), thereby preventing the action of both endogenous and xenobiotic opioids on these receptors without directly producing any effects itself.”