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Naloxone

Narcotic antagonist

FR: Reversal of respiratory depression caused by suspected narcotic intoxication

  • Allergy or known hypersensitivity to naloxone
  • Neonates

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

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

Titrate doses to improve spontaneous respiratory effort and minimize withdrawal symptoms.

Never administer naloxone to neonates

Follow weight-based dosing

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

Competitively antagonizes opioids bound to receptors in the central nervous system. 

  • Onset: 1-3 minutes (IM/IV)
  • Peak: 5-15 minutes (SC/IM/IV)
  • Duration: 30-45 minutes (IM/IV)
  • Sudden reversal of narcotic intoxication may provoke combativeness
  • May produce withdrawal signs and symptoms
  • Hypotension or hypertension
  • Nausea and vomiting, sweating, tachycardia

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. 

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