Usual Adult Dose for Opioid Overdose

Initial dose: 0.4 mg to 2 mg IV; alternatively, may give IM or subcutaneously

• If desired response is not obtained, doses should be repeated at 2 to 3 minute intervals
• If no response is observed with a total dose of 10 mg, the diagnosis of opioid-induced or partial opioid-induced toxicity should be questioned

Auto-injector: For emergency use in the home or other non-medical setting

• Administer 0.4 mg (1 actuation) IM or subcutaneously into the anterolateral aspect of the thigh (through clothing if necessary)
• If desired response is not achieved, a second dose may be administered after 2 or 3 minutes; additional doses may be administered every 2 to 3 minutes until emergency medical assistance arrives

Nasal Spray:

• Administer 1 spray intranasally into 1 nostril
• If desired response is not achieved after 2 or 3 minutes, give a second dose intranasally into alternate nostril; additional doses may be administered every 2 to 3 minutes in alternating nostrils until emergency medical assistance arrives

Comments:

• IV route is recommended in emergency situations since it has the most rapid onset of action.
• The duration of action of some opioids exceed that of this drug, therefore, repeat doses may be needed; the need for repeat doses will depend on the amount, type, and route of administration of the opioid being antagonized.
• Patients should remain under continued surveillance; if a patients responds and relapses back into respiratory depression, additional doses should be given.
• Additional supportive and/or resuscitative measures may be helpful while awaiting emergency medical assistance.

Use: For the emergency treatment of known or suspected opioid overdose as manifested by respiratory and/or central nervous system depression.

Usual Adult Dose for Reversal of Opioid Sedation

Initial dose: 0.1 to 0.2 mg IV at 2 to 3 minute intervals to the desired degree of reversal

• Supplemental doses administered IM have been shown to produce a longer lasting effect

Intravenous Infusion:

• A concentration of 0.004 mg/mL may be administered by IV infusion; titrate in accordance with patient's response

Comments:

• For the partial reversal of opioid depression following the use of opioids during surgery, smaller doses of naloxone are usually sufficient; larger than necessary doses may result in significant reversal of analgesia and increases in blood pressure.

Use: For the complete or partial reversal of opioid depression including respiratory depression, induced by natural and synthetic opioids and certain mixed agonist-antagonist analgesics.

Usual Pediatric Dose for Opioid Overdose

Neonates:
Initial dose: 0.01 mg/kg IV, IM, or subcutaneously; repeat dose every 2 to 3 minutes as needed

Children:
Initial dose: 0.01 mg/kg IV; if desired response is not obtained, may give 0.1 mg/kg IV

• If IV route is not available may give IM or subcutaneously in divided doses

Auto-injector: For emergency use in the home or other non-medical setting

• Administer 0.4 mg (1 actuation) IM or subcutaneously into the anterolateral aspect of the thigh (through clothing if necessary); if desired response is not achieved, a second dose may be administered after 2 or 3 minutes; additional doses may be administered every 2 to 3 minutes until emergency medical assistance arrives
• Under 1 year of age: Thigh muscle should be pinched while administering injection

Nasal Spray:

• Administer 1 spray intranasally into 1 nostril
• If desired response is not achieved after 2 or 3 minutes, give a second dose intranasally into alternate nostril; additional doses may be administered every 2 to 3 minutes in alternating nostrils until emergency medical assistance arrives

Comments:

• Neonatal opioid withdrawal syndrome may be life-threatening and should be treated according to protocols developed by neonatology experts.
• To avoid precipitating opioid withdrawal symptoms, consider use of a naloxone product that can be dosed according to weight and titrated to effect.
• The duration of action of some opioids will exceed that of this drug, therefore, repeat doses may be needed; the need for repeat doses will depend on the amount, type, and route of administration of the opioid being antagonized.
• Patients should remain under continued surveillance; if a patients responds and relapses back into respiratory depression, additional doses should be given.
• Additional supportive and/or resuscitative measures may be helpful while awaiting emergency medical assistance.

Use: For the emergency treatment of known or suspected opioid overdose as manifested by respiratory and/or central nervous system depression.

Usual Pediatric Dose for Reversal of Opioid Sedation

Neonates:
Initial dose: 0.01 mg/kg IV, IM or subcutaneously at 2 to 3 minute intervals to the desired degree of reversal

Children: 0.005 mg to 0.01 mg IV at 2 to 3 minute intervals to the desired degree of reversal

Intravenous Infusion:

• A concentration of 0.004 mg/mL may be administered by IV infusion; titrate in accordance with patient's response

Comments:

• For the partial reversal of opioid depression following the use of opioids during surgery, smaller doses of naloxone are usually sufficient; larger than necessary doses may result in significant reversal of analgesia and increases in blood pressure.

Use: For the complete or partial reversal of opioid depression including respiratory depression, induced by natural and synthetic opioids and certain mixed agonist-antagonist analgesics.

Renal Dose Adjustments

Use with caution

Liver Dose Adjustments

Use with caution

Dose Adjustments

Reversal of respiratory depression by partial agonists or mixed agonist/antagonists, such as buprenorphine and pentazocine, may be incomplete or require higher doses; if an incomplete response is observed, respirations should be mechanically assisted as clinically indicated.

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• May be administered IV, IM, subcutaneously, or intranasally depending on product

Auto-injector: IM or subcutaneous use only; For use by individuals in the community:

• Includes voice instructions; if voice instruction system does not operate properly, the auto-injector will still work when used according to the printed instructions on the label.
• Administer into the anterolateral aspect of the thigh
• In patients under the age of 1 year, pinch the thigh muscle while administering
• May administer through clothing if necessary
• Call for emergency medical help
• Each auto-injector contains 1 dose; use a new auto-injector for each additional dose

Nasal Spray: For use by individuals in the community:

• Remove nasal spray from packaging at time of use; each nasal spray contains 1 dose; do not prime nasal spray
• Lay patient on back while providing support to the back to the neck and allowing head to tilt back
• Hold with thumb on the bottom of the plunger and first and middle fingers on either side of the nozzle; place nozzle into nostril until fingers are against bottom of nose
• Press plunger firmly to administer dose
• Once administered move person to their side and call for emergency medical help
• Additional doses may be needed and should be administered in alternating nostrils with a new nasal spray for each dose

Storage requirements:

• Vials and ampules: Store at room temperature 25C (77F), excursions permitted to 15C to 30C (59F to 86F); protect from light
• Auto-injector: Store at room temperature 15C to 25C (59F to 77F), excursions permitted to 4C to 40C (39F to 104F); store in outer case provided; inspect solution prior to use to ensure it is not discolored

Nasal Spray: Store in blister pack until use; Store at room temperature 15C to 25C (59F to 77F), excursions permitted to 4C to 40C (39F to 104F); do not freeze; protect from light

Reconstitution/preparation techniques:

• May be diluted for IV infusion by adding 2 mg of naloxone to 500 mL of either normal saline or 5% glucose; resulting in a 0.004 mg/mL solution.
• If necessary naloxone may be diluted in sterile water for injection.
• Preparations must be used within 24 hours.
• Do not use the solution if it contains particulate matter and/or is discolored.

IV compatibility:

• Do not mix with preparations containing bisulfite, metabisulfite, long-chain or high molecular weight anions, or any solution having an alkaline pH.

General:

• The duration of action of some opioids exceed that of this drug, therefore, repeat doses may be needed; the need for repeat doses will depend on the amount, type, and route of administration of the opioid being antagonized.
• In opioid overdose, other resuscitative measures such as maintenance of a free airway, artificial ventilation, cardiac massage, and vasopressor agents should be readily available and utilized as needed; seek emergency medical care immediately after use of auto-injector.
• Naloxone may precipitate withdrawal in opioid-dependent patients; use cautiously in newborns of mothers who are known or suspected to be physically dependent on opioids. In such cases, an abrupt and complete reversal may precipitate an acute abstinence syndrome.

Monitoring:

• Keep patient under continued surveillance as repeated doses may be necessary.

Patient advice:

• Family members or caregivers should be educated about signs and symptoms of opioid overdose and urgency of treatment.
• Family members or caregivers should be aware of where this drug is being stored so it can be accessed quickly when needed; provided instructions on proper use, disposal, and need to immediately seek emergency medical care following use.
• A trainer auto-injector is supplied with the actual auto-injector, it may be used multiple times for training; do not confuse the actual auto-injector with the trainer in an emergency situation.

Frequently asked questions

• How do I get free Narcan emergency kits?
• How long does Narcan (naloxone) block opiates?
• What's the difference between naltrexone and naloxone?
• Will naloxone show up on a drug test?
• What are the different types of buprenorphine/naloxone?
• How does Narcan (naloxone) work in an overdose?
• How do you administer Narcan (naloxone)?
• Does Sublocade have naloxone in it?
• Is this an addictive drug?
• Will naloxone keep drug users from seeking treatment?
• How do you administer Narcan Nasal Spray?