| Summary: | John F Peppin,1,2 Joseph V Pergolizzi Jr,3– 5 Jeffrey Fudin,6– 8 Tricia A Meyer,9 Robert B Raffa3,5,10,11 1Marian University College of Osteopathic Medicine, Indianapolis, IN, USA; 2Pikeville University College of Osteopathic Medicine, Pikeville, KY, USA; 3Enalare Therapeutics Inc., Princeton, NJ, USA; 4NEMA Research Inc., Naples, FL, USA; 5Neumentum Inc., Summit, NJ, USA; 6Western New England College of Pharmacy, Springfield, MA, USA; 7Albany College of Pharmacy & Health Sciences Union University, Albany, NY, USA; 8Remitigate Therapeutics, Delmar, NY, USA; 9Texas A&M College of Medicine, Bryan, TX, USA; 10University of Arizona College of Pharmacy, Tucson, AZ, USA; 11Temple University School of Pharmacy, Philadelphia, PA, USACorrespondence: Robert B Raffa Tel +1 610-291-7019Email robert.raffa@temple.eduAbstract: The interest in substances that stimulate respiration has waxed and waned throughout the years, intensifying following the introduction of a new class of drugs that causes respiratory depression, and diminishing when antidotes or better drug alternatives are found. Examples include the opioids––deaths increasing during overprescribing, diminishing with wider availability of the opioid receptor antagonist naloxone, increasing again during COVID-19; the barbiturates––until largely supplanted by the benzodiazepines; propofol; and other central nervous system depressants. Unfortunately, two new troubling phenomena force a reconsideration of the status-quo: (1) overdoses due to highly potent opioids such as fentanyl, and even more-potent licit and illicit fentanyl analogs, and (2) overdose due to polysubstance use (the combination of an opioid plus one or more non-opioid drug, such as a benzodiazepine, sedating antidepressant, skeletal muscle relaxant, or various other agents). Since these now represent the majority of cases, new solutions are again needed. An interest in respiratory stimulants has been revived. This interest can be informed by a short review of the history of this interesting class of medications. We present a short history of the trajectory of advances toward more selective and safer respiratory stimulants.Keywords: overdose, respiratory depression, respiratory stimulant, carotid body, potassium channels
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