Naloxone

Aka: Naloxone, Narcan, Very Low Dose Naloxone Protocol

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