What are common administration routes for Narcan?

Narcan (naloxone) is available in different dose forms and can be given either as an injection or nasal spray to reverse an opioid overdose. The brand name for Narcan injection has been discontinued by the manufactirer. In addition, the autoinjector formulation Evzio and the generic alternative has been discontinued by the manufacturer.

• The injectable formulation can be given into a vein (intravenously), into the muscle (intramuscularly), or under the skin (subcutaneously). When first approved, naloxone treatments required administration via a syringe and needle and were most commonly used by trained medical personnel and emergency responders. Naloxone has been available in injection form to reverse the effects of an opioid overdose for over 40 years.
• Narcan (naloxone) nasal spray is a more user-friendly form for the general public who may be present as first responders for an overdose. Naloxone nasal spray can be more easily administered by a lay-person to someone having an opioid overdose. The nasal spray was designed to be used at home without the need for medical training. In March 2023, the FDA approved Narcan Nasal Spray as an over-the-counter (OTC) product.

Naloxone is not a substitute for emergency medical care. During any opioid overdose emergency, call 911 or other emergency responders immediately after giving naloxone to the person who has overdosed. A repeat dose or a higher dose of naloxone may be needed. Keep the person under surveillance until emergency personnel arrive.

How do I use Narcan Nasal Spray?

Narcan (naloxone) Nasal Spray can be used for adults or children.

1. Remove the Narcan Nasal Spray (naloxone nasal spray) from the box. DO NOT prime the device before administering.
2. Place your thumb on the plunger bottom and your first and middle fingers on either side of the nozzle.
3. The drug is sprayed into one nostril while the person is lying down on their back. Tilt the person’s head back and provide neck support with your hand.
4. Gently insert the nozzle tip in one nostril until your fingers on either side of the nozzle touch the bottom of the person’s nose.
5. Press the plunger firmly to give the full dose. Remove the spray bottle from the nose after the dose is given.
6. Call 911 or get emergency medical help right away after giving the first dose of Narcan Nasal Spray.
7. Move the person to their side (recovery position). If symptoms return or the person does not respond by waking up to voice or touch, give another dose in the other nostril after 2 to 3 minutes using a new Narcan Nasal Spray.
8. Use alternate nostrils with each dose until emergency medical assistance arrives. Narcan Nasal Spray may be given every 2 to 3 minutes, if available.

Fully review directions enclosed in the box when you receive the medication; do not wait until an overdose situation occurs. It is not addictive or considered an opioid itself.

Injectable naloxone hydrochloride

• The naloxone hydrochloride injectable formulation is used in clinic and hospital settings as an intravenous or intramuscular injection.
• Kit with 2 syringes and 2 vials of 0.4 mg/mL injectable naloxone may also be sold to emergency first-responders.
• Naloxone vials may also sold in a kit with nasal atomizers for use as a nasal spray.
• All kits contain an instruction chart for use and assembly direction.
• Brand name Narcan injectable is no longer marketed.

Where can I get Narcan (naloxone)?

Most states have now passed legislation designed to improve lay-person access to naloxone at the pharmacy. More user-friendly naloxone products allow first-responders, the lay public, and family or friends to quickly administer naloxone in a life-threatening opioid (narcotic) overdose situation before emergency medical help arrives.

Narcan Nasal Spray is approved in a 4 mg strength. It can easily be carried in a purse or pocket or stored in the home. No additional device assembly is required.

In March 2023, the FDA approved an Rx-to-OTC switch for Narcan 4 mg Nasal Spray for over-the-counter (OTC), nonprescription use. The FDA’s action now allows Narcan to be sold directly to consumers at drug stores, convenience stores, grocery stores, gas stations, and online. It is expected to be available on shelves by the end of the summer, 2023. The FDA granted the OTC approval of Narcan to Emergent BioSolutions.

You can store Narcan Nasal Spray store at room temperature 68°F to 77°F (20°C to 25°C). It does not need to be refrigerated. Do not freeze.

Kloxxado (naloxone hydrochoride) from Hikma Pharmceuticals was approved in April 2021 and is a higher dose nasal naloxone spray. Kloxxado delivers 8 mg of naloxone per spray, compared to the 4 mg per spray for Narcan Nasal.

Zimhi (naloxone) 5 mg/0.5 mL injection from Adamis Pharmaceuticals is a single-dose, prefilled syringe and given via intramuscular or subcutaneous injection into the thigh, through clothing if necessary.

Bottom Line

Narcan (naloxone) is given to reverse slowed or stopped breathing, extreme sedation, and unconsciousness that occurs in someone who experiences an opioid (narcotic) overdose.

Naloxone is available as a naloxone nasal spray (brand example: Narcan Nasal, Kloxxado). These products that are easier for the general public, friends and family to administer. Narcan was approved by the FDA as an over-the-counter, nonprescription product in March 2023.

Naloxone can also be given by intravenous, intramuscular or subcutaneous injection. It may be given this way more frequently in a clinic, hospital or by emergency responders.

This is not all the information you need to know about naloxone for safe and effective use in an emergency overdose. Review the the use of naloxone or Narcan Nasal Spray before an emergency overdose situation, and discuss this information with your doctor or other health care provider.