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NaloxoneAka: Narcan, Very Low Dose Naloxone Protocol

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  1. See Also
    1. Nalmefene (Revex)
  2. Physiology
    1. Pure Narcotic antagonist
    2. Action in under 2 minutes
    3. Effect lasts 45 minutes
  3. Indication: Narcotic overdosage
    1. Respiratory depression
    2. Sedation
    3. Hypotension
    4. Hypoperfusion
  4. Narcotic examples reversed by naloxone
    1. Heroin
    2. Methadone
    3. Pentazocine
    4. Propoxyphene
  5. Narcotics requiring increased naloxone dosing
    1. Propoxyphene
    2. Pentazocine
    3. Buprenorphine
  6. Pharmacokinetics
    1. Onset: 1-2 minutes
    2. Duration: 1-2 hours
  7. Dosing: General
    1. Route:
      1. Reliable: IV, IO, and ET
      2. Erratic absorption: IM and SQ
    2. Single dose
      1. Child
        1. Under 5 years (under 20 kilograms): 0.1 mg/kg
        2. Over 5 years (over 20 kilograms): 2.0 mg
      2. Adult
        1. Dose: 0.4 to 2.0 mg IVP
        2. Start with 0.4 mg if suspecting severe withdrawal
    3. Repeat dosing
      1. May repeat at 2-3 minutes intervals
      2. Maximum total dose: 10 mg
    4. Infusion (for long acting Narcotic reversal)
      1. Dose: 0.04 to 0.16 mg/kg/h
  8. Dosing: Very Low Dose Naloxone Protocol
    1. Indications: Prevent severe rebound pain that would occur with complete Opioid reversal
      1. Cancer Pain
      2. Chronic Pain
    2. Prepare a 0.04 mg/ml Naloxone solution
      1. Start with one naloxone ampule 0.04 mg/ml
      2. Add saline to make total dose of 10 ml
    3. Dosing protocol
      1. Administer 0.01 to 0.04 mg (or 1.5 mcg/kg) IV or IM
      2. Repeat dose every 3-5 minutes as needed
        1. Titrate dose to Respiratory Rate and mental status
  9. Precautions
    1. Recurrence of Narcotic intoxication
      1. Occurs if Narcotic half life is longer than naloxone
      2. Infusion may be useful with longer acting Opioids
    2. Infants born to addicted mothers
      1. Naloxone may precipitate acute withdrawal or Seizures
    3. Restrain patient overdose prior to administration
      1. May precipitate withdrawal

Naloxone (C0027358)

Definition (MSH)A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors.
Definition (CSP)specific opiate antagonist with no agonist activity, a competitive antagonist at mu, delta, and kappa opioid receptors.
Definition (NCI)A thebaine derivate with competitive opioid antagonistic properties. Naloxone reverses the effects of opioid analgesics by binding to the opioid receptors in the CNS, and inhibiting the typical actions of opioid analgesics, including analgesia, euphoria, sedation, respiratory depression, miosis, bradycardia, and physical dependence. Naloxone binds to mu-opioid receptors with a high affinity, and a lesser degree to kappa- and gamma-opioid receptors in the CNS.
Definition (NCI)A substance that is being studied as a treatment for constipation caused by narcotic medications. It belongs to the family of drugs called narcotic antagonists.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD009270
EnglishNaloxone, NALOXONE PREPARATION, NLX
Spanishnaloxona
Parent Conceptsthebaine and derivatives (C0682977), Morphine (C0026549), Narcotic Antagonists (C0027410), Morphinans (C0026548), [CN102] OPIOID ANTAGONIST ANALGESICS (C0973498), Drug allergen (C1320237), Drugs used to treat addiction (C1629845)
SourcesAOD, CSP, LCH, LNC, MSH, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Narcan (C0684237)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD009270
EnglishBoots Brand of Naloxone Hydrochloride, Bristol Myers Squibb Brand of Naloxone Hydrochloride, Bristol-Myers Squibb Brand of Naloxone Hydrochloride, Endo Brand of Naloxone Hydrochloride, Lamepro Brand of Naloxone Hydrochloride, Narcan, Narcanti, United Drug Brand of Naloxone Hydrochloride
SourcesAOD, MSH, MTH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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