Perinatal EvidenceCompass
Prepopulated workbenchMED-229

Substance-use disorder — alcohol

Nalmefene nasal spray

Opioid overdose rescue; not alcohol-use-disorder treatment

Brand / product examples: Opvee

Not a categorical safety rating

This record organizes questions; it does not close them.

The clinical fields and position statements are prepopulated from the public-source corpus. They have not completed individual dual extraction, formal appraisal, exact-label reconciliation, or multidisciplinary sign-off. Do not use this page to justify abrupt discontinuation or reflexive switching.

Inventory identity

What this record represents

Canonical generic name
Nalmefene nasal spray
Entity type
single-ingredient drug
Active component(s)
Nalmefene nasal spray
Formulation / route / interval
Intranasal spray for opioid overdose reversal
Attachment entry
Nalmefene — US rescue formulation (added reconciliation)
Separate monograph status
Yes — distinct US indication/route
Identity and cross-reference
Not populated in v0.95
Inventory verification confidence
Moderate — molecule-level source; exact product/jurisdiction pending

Decision taxonomy

Five positions kept separate

These are workbench statements for reviewer execution. They are not independently commissioned, patient-specific recommendations.

  1. 01

    Stable continuation

    Workbench statement

    Do not withhold or discontinue solely because of pregnancy or lactation. For this record, assess indication, prior response, relapse severity, dose/formulation, alternatives, exposure timing, and mapped evidence; individual commissioned adjudication remains pending.

  2. 02

    New initiation in pregnancy

    Workbench statement

    For a new start, prefer an effective option with the strongest diagnosis-specific efficacy and reproductive evidence when clinically suitable. This record has not received an individual, independently verified initiation ranking.

  3. 03

    Switch before conception

    Workbench statement

    Before conception, consider a switch only when expected benefit exceeds relapse, withdrawal, failed-switch, and dual-exposure risks. Build and monitor the plan before pregnancy when feasible; no universal switch direction is assigned here.

  4. 04

    Unplanned exposure

    Workbench statement

    After unplanned exposure, confirm product, route, dose, timing, indication, co-exposures, and symptoms; do not advise abrupt cessation. Use the mapped evidence and current label to decide whether any targeted fetal assessment is indicated.

  5. 05

    Delivery, postpartum & lactation

    Workbench statement

    Create separate delivery, postpartum-dose, neonatal-observation, and lactation plans. Do not infer breastfeeding suitability from pregnancy evidence or routinely taper before delivery without drug-specific support.

Linked evidence

2 mapped claim summaries

Mapping can include class-wide, framework, formulation, regulatory, or evidence-gap claims. A linked claim is not necessarily a drug-specific causal estimate.

C-009Provisional public source

Naloxone should not be withheld in a suspected opioid overdose because of pregnancy; naloxone and nalmefene rescue products reverse overdose but do not treat OUD.

Public-source certainty descriptor
High emergency consensus; pregnancy comparative trials infeasible
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
Acute overdose in pregnancy or postpartum
Comparator
Rescue treatment versus no reversal
Effect or numbers carried forward

Immediate reversal benefit outweighs fetal concern in life-threatening maternal hypoxia

Limitations

Recurrent toxicity and precipitated withdrawal require observation; nalmefene has longer action and less pregnancy experience

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
C-016Provisional public source

Oral nalmefene for AUD and intranasal nalmefene for opioid overdose are different indications and formulations and must never be conflated.

Public-source certainty descriptor
High identity and regulatory certainty
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
All windows
Comparator
Selincro oral versus Opvee intranasal
Effect or numbers carried forward

Not applicable

Limitations

Oral nalmefene is jurisdiction-specific and has inadequate pregnancy evidence

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending