Naloxone

General

• Type: Opioid antagonists, antidote
• Dosage Forms:
• Common Trade Names: Narcan

Adult Dosing

Opioid toxicity

• Bolus (May repeat q3min up to max dose 10mg
  • Apneic or near-apneic - 2mg IV
  • Opioid-naive with minimal respiratory depression - 0.4mg IV
  • Opioid-dependent with minimal respiratory depression - 0.05mg IV
• Infusion
  • Only give if the patient responded to the bolus and required repeat administration
  • Step 1: Determine the "wake-up dose" or bolus required to wake the pt
  • Step 2: Give 2/3 of the "wake-up dose" per hr; mix in 1L D5W

Pediatric Dosing

• IV: 0.005 to 0.01mg/kg IV every 2 to 3 minutes as needed to desired degree of reversal
• If IV route is not available, may administer in divided doses IM

Special Populations

• Pregnancy Rating: C
• Lactation: insufficient data
• Renal Dosing
  • Adult
  • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

Contraindications

• Allergy to class/drug

Adverse Reactions

• Opioid withdrawal
• Non-cardiogenic pulmonary edema
• Serious complications are rare

Pharmacology

• Metabolism: hepatic
• Excretion: renal
• Mechanism of Action: opioid antagonist
• Onset of action - 1-2min
• Duration of action - 20-90min (may be less than that of the ingested opioid)
• For this reason many hospital algorithms call for ~3 hours of ED observation prior to discharge
• Some small studies have called for decreasing this time frame to 1 hour but there are often adverse events in a significant proportion of these patients (one study showed that 15% of patients had adverse events such as need for supplemental oxygen after attempting discharge at 1 hour).

See Also

• Opioid toxicity
• Opioid withdrawal