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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

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

Pediatric Considerations And Dosing

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

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.