Naloxone

Question 1

Classification: Naloxone

Answer 1

Narcotic (Opioid) antagonist

Question 2

How is naloxone supplied?

Answer 2

0.4 mg/mL, 1 mg/mL

Question 3

MOA: Naloxone

Answer 3

Antagonizes most opioid effects especially respiratory depression, sedation and hypotension.

Question 4

Indications: Naloxone

Answer 4

Known or suspected narcotic-induced respiratory depression, including those caused by natural and synthetic narcotics

Question 5

Adult Dosage: Naloxone

Answer 5

• IV/IO (preferred route) 0.2-0.4 mg; repeat IV/IO 2 min prn max of 1.6 mg
• IM 0.4 - 0.8 mg; repeat IM q 5 min prn max 3.2mg
• Intranasal 2 mg (1mg/nostril); repeat intranasal q 3-5 min prn max 4 mg
• Infusion: 0.4mg in a 50 or 100ml NS/D5W running over 60 minutes

Question 6

Pediatric Dose: Naloxone

Answer 6

0.1 mg/kg slow IV/IO/IM/IN max 2mg q 5 min prn. Infusion 0.16mg/kg/hr IV/IO over 60 minutes.

Question 7

Contraindications: Naloxone

Answer 7

❑ Hypersensitivity to drug or any components (rare anaphylactic reactions have been reported)
❑ Avoid in meperidine induced seizures

Question 8

Precautions: Naloxone

Answer 8

❑ Caution in opiate dependent pts; may become very agitate or violent
❑ May require higher dosages with drugs such as Talwin, Darvon
❑ Use cautiously in patients with cardiac irritability.
❑ Opiate addiction: may cause withdrawal symptoms in these patients.
❑ Opioid-induced respiratory depression usually lasts longer than the duration of Narcan, therefore repeated doses may be necessary
❑ Administration to infants of addicted mothers may precipitate seizures or other withdrawal symptoms

Question 9

Notes: Naloxone

Answer 9

❑ If total reversal is not required, smaller doses of 0.04 mg IV repeated every 2-3 minutes may be used
❑ Ensure ventilation is performed (if tolerated) prior to administration of Narcan to avoid sympathetic stimulation
❑ With potential opioid dependent patients, consider administering 0.4 mg increments to improve respiratory depression but not to awake the patient due to risk of agitation and combativeness.
❑ In persons with long-term addictions or cardiovascular disease, naloxone may markedly increase heart rate and blood pressure and cause acute pulmonary edema, cardiac arrhythmias (including asystole), and seizures.