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in a life-or-death OPIOID overdose SITUATION

WHICH WOULD YOU CHOOSE?

Figure 1 Mean ± SD Plasma Concentration of Naloxone, (a) 0–30 min and (b) 0–12 h Following a Single Intramuscular Administration of 5 mg ZIMHI and a Single Intramuscular Administration of 2 mg Naloxone HCl
ZIMHI
2-MG IM NALOXONE

FASTER

Reaches the Cmax for 2-mg IM naloxone in only ≈4 minutes5

GREATER

Achieves a 4.8× higher Cmax than 2-mg IM naloxone5

LASTING

Maintains >2.5× greater concentration than 2-mg IM naloxone at 1 hour5

2025 CLINICAL STUDY IM VS. IN

A comparison of intramuscular (Zimhi) and intranasal naloxone (Narcan) in reversal of fentanyl-induced apnea: a randomized, crossover, open-label trial. Published: 19 May 2025, Nature Communications 2025; 16:4659. This study was a randomized, crossover, open-label trial looking at the outcomes of 16 people comparing intramuscular (IM) naloxone to intranasal (IN) naloxone after having an induced opioid breathing event.1

  1. IM naloxone was more effective than IN naloxone: People usually needed fewer doses of IM naloxone to restore normal breathing compared to IN naloxone.1
  2. Fewer people needed extra help: No one in the IM group needed backup IV naloxone, while one person in the IN group did.1
  3. Results were statistically significant: The difference in dose requirements between IM and IN naloxone was unlikely due to chance.1
    • IM naloxone worked more efficiently than IN naloxone to reverse breathing problems, as shown by the number of doses needed to restore normal breathing (median dose of 1.5 for IM and 2.0 for IN) (p=0.0002)
  4. IM naloxone was 2 minutes faster at completely reversing an episode than IN naloxone1
    • On average, the time to reversal was 2.2±0.8 minutes (mean±SD; n=16) after IM naloxone and 4.0±2.0 minutes after IN naloxone, with a mean difference of 2.0 min (95% CI 1.1 to 2.9 min, p=0.0002)

In the United States, synthetic Opioid overdoses are becoming increasingly challenging to manage

Fentanyl:

100x mORE pOTENT

than morphine with a faster onset of action2,3

Carfentanil:

10,000x mORE pOTENT

than morphine—the most potent fentanyl analog in the United States4

430% increase

in seized fentanyl-laced counterfeit pills since 2019; 40% contained a potentially lethal dose5

ZIMHI IS Built for FIRST RESPONDERS

  • Ready to Use
  • No Need to Draw from Bottle
  • Proven effective in head to head studies1
  • Transport in easy to carry plastic hard case
  • COMING SOON: Custom belt pouches for single and double pack use

Recently featured in Journal Of Emergency Medicine (JEMS) article Click here

Click for more information

ZIMHI IS Built for FIRST RESPONDERS

  • Ready to Use
  • No Need to Draw from Bottle
  • Proven effective in head to head studies1
  • Transport in easy to carry plastic hard case
  • COMING SOON: Custom belt pouches for single and double pack use

Recently featured in Journal Of Emergency Medicine (JEMS) article Click here

Click for more information

REFERENCES

  1. A comparison of intramuscular (Zimhi) and intranasal naloxone (Narcan) in reversal of fentanyl-induced apnea: a randomized, crossover, open-label trial. Published: 19 May 2025, Nature Communications 2025; 16: 4659 Maarten A. van Lemmen,  Monique van Velzen,  Elise Y. Sarton,  Albert Dahan, Marieke Niesters
  2. Fentanyl. United States Drug Enforcement Administration. Accessed December 22, 2021. https://www.dea.gov/factsheets/fentanyl
  3. Stanley T. H. The fentanyl story. J Pain. 2014;15(12):1215-1226. doi: 10.1016/j.jpain.2014.08.010
  4. Fatal Intoxication with Acetyl Fentanyl Journal of Forensic Sciences 61:p S276-S280, January 2016. | DOI: 10.1111/1556-4029.12953 Susan M. Cunningham Nabila A. Haikal James C. Kraner
  5. ZIMHI Prescribing information

INDICATION

ZIMHI is an opioid antagonist indicated for the emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression in adult and pediatric patients. ZIMHI is intended for immediate administration as emergency therapy in settings where opioids may be present. ZIMHI is not a substitute for emergency medical care.

IMPORTANT SAFETY INFORMATION

As the duration of action of naloxone hydrochloride is shorter than many opioids, keep the patient under continued surveillance and administer repeated doses of naloxone using a new ZIMHI device, as necessary, while awaiting emergency medical assistance. Seek emergency medical assistance immediately after the first dose.
Reversal of respiratory depression caused by partial agonists or mixed agonists/antagonists, such as buprenorphine and pentazocine may be incomplete. Repeat doses of ZIMHI may be required.
Use in patients who are opioid dependent may precipitate opioid withdrawal. In neonates, opioid withdrawal may be life-threatening if not recognized and properly treated. Monitor for the development of signs and symptoms of opioid withdrawal.
Abrupt postoperative reversal of opioid depression may result in adverse cardiovascular (CV) effects. These events have primarily occurred in patients who had pre-existing CV disorders or received other drugs that may have similar adverse CV effects. Monitor these patients closely in an appropriate healthcare setting after use of naloxone hydrochloride.
After use, the ZIMHI needle is exposed until the safety guard is deployed. A needlestick injury could occur during use in emergency situations. In the event of accidental needlestick injury, medical attention should be sought.
The following adverse reactions were most commonly observed in ZIMHI clinical studies: dizziness, lightheadedness, nausea, and elevated bilirubin.

To report SUSPECTED ADVERSE REACTIONS, call 1-800-230-3935 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

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