Nalmefene is a narcotic NMDA receptor antagonist that reduces the excitatory neurotransmitter release, which contributes to cellular injury in early ischemia. Unlike the NMDA receptor antagonists, this drug causes minimal side effects. Post hoc analyses in early Phase 2 trials suggested that nalmefene (Cervene, Baker Norton) might have greater efficacy in younger patients (<70 years of age) than in older patients (12). However, results of a Phase 3 clinical trial, in which the drug was administered intravenously within 6 hr of symptom onset in patients <70 years, showed no clinical benefit on any of the outcome measures (13). No further trials are planned.

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