Naloxone
Classification
Narcotic antagonist
Indications
FR: Reversal of respiratory depression caused by suspected narcotic intoxication
Contraindications
- Allergy or known hypersensitivity to naloxone
- Neonates
Adult dosages
FR: Reversal of respiratory depression caused by suspected narcotic intoxication
- 0.4 mg IM every 3 minutes as required; maximum 3 doses
- Option: IN administration using metered device every 3 minutes as required; maximum 3 doses
EMR: Reversal of respiratory depression caused by suspected narcotic intoxication
Naloxone IM every 3 minutes as required; maximum 4 doses
- First dose: 0.4 mg IM
- Second dose: 0.4 mg IM if required
- Third dose: 0.8 mg IM if required
- Fourth dose: 2 mg IM if required
- CliniCall consultation required prior to administration of further doses
PCP: Reversal of respiratory depression caused by suspected narcotic intoxication
Naloxone IM/IV every 3 minutes as required; maximum 4 doses
- First dose:0.4 mg IM/IV
- Second dose: 0.4 mg IM/IV if required
- Third dose: 0.8 mg IM/IV if required
- Fourth dose: 2 mg IM/IV if required (IV preferred)
- CliniCall consultation required prior to administration of further doses
*Palliative patient populations: titrating 0.1mg IM/IV/min for opioid overdose in the palliative patient to reverse respiratory depression without interfering with pain contro
ACP: Reversal of respiratory depression caused by suspected narcotic intoxication
- As per PCP schedule
- May also consider, in order:
- 4 mg IV
- CliniCall consultation required prior to administration of further doses
- 10 mg IV
- 4 mg IV
Titrate doses to improve spontaneous respiratory effort and minimize withdrawal symptoms.
Pediatric Considerations And Dosing
Never administer naloxone to neonates
FR: Not authorized for use in pediatrics
EMR: Reversal of respiratory depression caused by suspected narcotic intoxication
- 0.1 mg/kg (to maximum of 2 mg per dose); repeat every 3 minutes; maximum 4 doses
- Higher dose for pediatric patients as they are unlikely to experience withdrawal
Mechanism Of Action
Competitively antagonizes opioids bound to receptors in the central nervous system.
Pharmacokinetics
- Onset: 1-3 minutes (IM/IV)
- Peak: 5-15 minutes (SC/IM/IV)
- Duration: 30-45 minutes (IM/IV)
Adverse Effects
- Sudden reversal of narcotic intoxication may provoke combativeness
- May produce withdrawal signs and symptoms
- Hypotension or hypertension
- Nausea and vomiting, sweating, tachycardia
Warning And Precautions
Some evidence exists that suggests naloxone may be heat sensitive, losing some potency after 4+ weeks of storage at temperatures consistently above 40°C. Degraded medication is unlikely to be harmful to patients, but may not carry the same clinical effects, thus requiring higher doses.