Opvee vs. Narcan: 6 Similarities and Differences Between These Opioid Reversal Medications

Key takeaways:

• Opvee (nalmefene) and Narcan (naloxone) are emergency nasal spray medications that can reverse an opioid overdose.
• Opvee is a prescription-only medication. Narcan is available over the counter.
• Opvee stays in the body longer than Narcan. One study found that Opvee may work more quickly — especially for overdoses caused by long-acting opioids like fentanyl. But it may also cause longer-lasting opioid withdrawal symptoms. Nausea, sweating, and a fast heartbeat are a few examples.

If you or a loved one take an opioid for pain relief, it’s a good idea to have an overdose reversal medication on hand. Just like having a fire extinguisher in your home in case there’s an unexpected fire, keeping an opioid reversal medication handy can help protect you and your family in the event of an emergency. After all, accidental overdoses can happen to anybody — no matter your background or history of opioid use.

Opvee (nalmefene) and Narcan (naloxone) are two life-saving medications that can reverse opioid overdoses in kids and adults. They’re both fast-acting nasal sprays, but they have some key differences you should be aware of. Knowing more about these medications can help you decide which one is right for you. Here are six FAQs to consider about nalmefene versus naloxone.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

EXPERT PICKS: WHAT TO READ NEXT

• Responding to an opioid overdose: Knowing what steps to take in an overdose situation can help save a life. 
• Getting Narcan OTC: You can find Narcan nasal spray OTC. Learn about how you can get it for free through various state and city programs.
• Symptoms of opioid withdrawal: Opioid withdrawal symptoms are the most common side effects of Narcan and Opvee. Knowing what to expect can help you manage them.

1. How does nalmefene differ from naloxone?

Opvee and Narcan are used in similar situations. But they contain different medications. Opvee contains nalmefene as its active ingredient. Naloxone is the active ingredient found in Narcan.

Another factor that separates nalmefene versus naloxone is how they’re available and who can use them. Nalmefene is available as:

• Opvee, a 2.7 mg nasal spray
• Zurnai, a 1.5 mg nalmefene injection (available as a single dose auto-injector)
• Generic nalmefene, a 1 mg/mL injection (only available for use in a healthcare setting)

All forms of nalmefene are prescription only. People ages 12 years and older can use Opvee and Zurnai.

Naloxone is available as:

• Narcan, a 4 mg nasal spray
• RiVive, a 3 mg naloxone nasal spray
• Kloxxado, an 8 mg nasal spray
• Generic naloxone, a 0.4 mg/mL and 1 mg/mL injection
• Zimhi, a 5 mg injection (available as a single dose auto-injector)

Narcan and RiVive nasal sprays are available over the counter (OTC). Other naloxone products require a prescription. Most naloxone products don’t have age restrictions, except Zimhi which isn’t meant for children under the age of 12.

2. Do Opvee and Narcan work the same way?

Yes. Opvee and Narcan are both opioid antagonists that can quickly reverse an opioid overdose. However, Opvee lasts longer in the body than Narcan.

Both medications work by blocking certain opioid receptors (chemical binding sites) in the brain. When someone takes too much of an opioid (or combines it with other substances), breathing can slow down or stop completely. Opvee and Narcan push opioids off of these receptors to help restore breathing.

Think of this strategy like an airport. Just like passengers can’t board a plane if it’s not attached to the gate, opioids have trouble working if their receptors are blocked.

3. Are Opvee and Narcan administered the same way?

Yes, for the most part. They’re both designed to be easy to give.

If you or someone you know is experiencing signs and symptoms of an opioid overdose, it’s important to act quickly and administer Opvee or Narcan. Common symptoms of an overdose include, but aren’t limited to, slow or irregular breathing, pinpoint pupils, and a loss of consciousness. Each nasal spray device contains one dose. Both medications are packaged to include two nasal sprays, since one dose isn’t always enough to reverse an overdose.

Below, we’ll give instructions for administering Opvee or Narcan. After administering the first dose of Opvee or Narcan, call 911. They can send emergency personnel your way. Your 911 agent can also tell you if it’s necessary to start CPR.

Instructions for administering Opvee or Narcan are below:

1. If you think someone is experiencing an overdose, lay the person on their back. Tilt their head back while supporting the back of their neck.
2. Insert the medication nozzle into a nostril and press the plunger to give one dose. It’s important to not prime (test) the nasal spray before administering it because you’ll lose the dose.
3. Roll the person to their side.
4. Call 911
5. If you’re giving Opvee and the person doesn’t wake up after 2 to 5 minutes, give another dose. For Narcan, you can give another dose if the person is unresponsive after 2 to 3 minutes. You can continue repeating these steps if the person doesn’t wake up.

If you aren’t sure if someone is experiencing an opioid overdose, it’s a good idea to administer the medication anyway. These reversal medications don’t cause any harm if they’re administered to someone who’s not actually experiencing an overdose.

Family and friends of anyone taking opioids should have access to these reversal medications and know how to administer them. This is because a person who experiences an opioid overdose will likely be unconscious — making it impossible to administer their own dose.

4. Does Opvee have more side effects than Narcan?

Not necessarily. Opioid withdrawal symptoms are the most common side effects of both Opvee and Narcan. But as mentioned above, opioid withdrawal symptoms caused by Opvee may last longer than those caused by Narcan. However, keep in mind that having opioid withdrawal symptoms is almost always less risky than not treating an opioid overdose. 

Below is a table of potential Opvee and Narcan side effects. Several of these are considered symptoms of opioid withdrawal, rather than a side effect of Opvee or Narcan itself.

5. Is Opvee harder to obtain than Narcan?

Opvee may be harder to obtain than Narcan because you need a prescription from a healthcare professional to access it.

As mentioned, Narcan and RiVive are available for OTC purchase. You can find it online, at pharmacies, and at many big box retailers. In some cases, you may also be able to find Narcan for free.

Reach out to your pharmacist or prescriber about how and where to find Opvee and Narcan. And keep in mind that even if you don’t take opioids, you can still get Opvee or Narcan to keep with you. This is a good idea if someone in your household takes opioids.

6. Is Opvee as effective as Narcan?

Yes, Opvee and Narcan are both effective opioid overdose reversal medications.

One small head-to-head study of 50 participants found that Opvee improved breathing more quickly than naloxone after an opioid overdose compared to naloxone. This was after researchers administered remifentanil (Ultiva) to participants — a synthetic (lab-made) opioid that’s similar to fentanyl but with a faster onset of action.

What’s more, Opvee lasts over 5 times longer in the body than Narcan, meaning it doesn’t wear off as quickly. This may help limit the number of doses a person needs to reverse an opioid overdose. This may be especially important for overdoses caused by long-acting opioids, such as fentanyl, which can stick around in the body for several hours.

However, there may be a downside to Opvee lasting longer in the body. Both Opvee and Narcan can cause opioid withdrawal symptoms. But withdrawal symptoms caused by Opvee can last longer, since it doesn’t leave the body as quickly. These symptoms  — such as nausea, vomiting, and agitation — can be extremely uncomfortable. So for some people, the fact that Narcan doesn’t last as long in the body is considered a benefit.

With all this information in mind, what’s the verdict on Opvee versus Narcan? Which should you carry? And in truth, there’s no clear cut answer. Opvee may last longer in the body, but most medical experts aren’t recommending that the general public switch from carrying Narcan to Opvee. We need more research comparing these two medications before a firm recommendation can be made. But trust that both options are effective in reversing opioid overdoses.

How to save on Opvee and Narcan

There are ways to save on Narcan, which is available as a brand-name and generic product. You may also be able to save on Opvee, which is only available as a brand-name.

• Access Narcan for free in certain areas. Certain cities, states, and non-profit organizations offer free Narcan. Opvee hasn’t been available for long, so programs offering it for free aren’t as common.
• Check with your insurance. If you have health insurance, your plan may cover all or part of your Narcan or Opvee purchase with a prescription.
• Save with GoodRx. If you have a prescription and fill it through the pharmacy, generic Narcan nasal spray’s price at certain pharmacies is as low as $36.40 with a free GoodRx discount. Additionally, RiVive’s price at certain pharmacies is as low as $37.14. Additionally, you may be able to obtain Opvee at some pharmacies for $104.87.

What’s more, OTC Narcan’s list price is $45 per package and OTC RiVive’s list price is $36 per package. If you have a flexible spending account (FSA) or health savings account (HSA), it may cover OTC Narcan or RiVive.

The bottom line

Opvee (nalmefene) and Narcan (naloxone) are life-saving nasal sprays that can reverse an opioid overdose. One key difference between these opioid blockers is how long they last. Opvee stays in the body longer than Narcan does. But Opvee requires a prescription from a healthcare professional, unlike Narcan which is available over the counter. 

If you or a loved one takes an opioid, it’s a safe bet to have a reversal medication like Opvee or Narcan on hand as a precaution. When comparing nalmefene versus naloxone, one isn’t necessarily preferred over the other. So talk to your healthcare team and see what they recommend you carry.