NALOXONE
(Narcan)Standard Prescription
naloxone__mg IM/IV/SC x 1 dose (__mg/kg/dose) (repeat Q__min prn)
Infusion: naloxone __ mcg/kg/hr IV
Infusion: naloxone __ mcg/kg/hr IV
Dosages
Bolus Doses for Partial Reversal of Opioid-Induced Respiratory Depression:
0.01 mg/kg/dose (max dose: 0.4 mg/dose) IV/IM/SC. Repeat PRN Q2-3 min
0.1 mg/kg/dose IV/IM/SC/IO (max dose: 2 mg). Repeat PRN Q2-3 min
Children > 5 years or > 20 kg:
2 mg/dose IV/IM/SC/IO. Repeat PRN Q2-3 min
Initial dose: 40 mcg/kg/hr. Titrate to clinical effect. Doses up to 160 mcg/kg/hr have been reported
Initial adult dose: 0.4- 0.8 mg/hr. Titrate to clinical effect
Usual start dose: 1 mcg/kg/hr
0.01 mg/kg/dose (max dose: 0.4 mg/dose) IV/IM/SC. Repeat PRN Q2-3 min
Bolus Doses for Full Reversal:
Children < 5 years or < 20 kg: 0.1 mg/kg/dose IV/IM/SC/IO (max dose: 2 mg). Repeat PRN Q2-3 min
Children > 5 years or > 20 kg:
2 mg/dose IV/IM/SC/IO. Repeat PRN Q2-3 min
Suspected or Known Opioid intoxication:
Children and adults: 0.2-0.4 mg/dose IV/IM/SC. Repeat PRN Q2-3 min. May require 2 mg/dose or up to 15 mg in total for larger overdoses or street opioidsContinuous IV Infusion for Opioid Intoxication:
See DPIC Poison Management ManualInitial dose: 40 mcg/kg/hr. Titrate to clinical effect. Doses up to 160 mcg/kg/hr have been reported
Initial adult dose: 0.4- 0.8 mg/hr. Titrate to clinical effect
Continuous IV Infusion to Prevent Opioid-induced Pruritus (with concomitant infusion of parenteral opioids) (by APS only) :
0.25 - 1.65 mcg/kg/hr Usual start dose: 1 mcg/kg/hr
Mechanism of Action
Opiate Antagonist
Forms Supplied
injection: 0.4 mg/mL, 1 mg/mL
Comments
Dose dependent reversal of opioid effects.
IV route preferred; IM and SC may have delayed or erratic absorption.
Bolus dose naloxone must always be prescribed to treat inadvertent respiratory depression when opioid infusions are prescribed.
Short duration of action may necessitate repeated doses. May need repeated doses every 20-60 mins or continuous infusion if duration of action of opioid longer than naloxone. Patient should be closely monitored.
Analgesia will also be reversed by naloxone.
Abrupt reversal of opioid effects may induce opioid withdrawal, nausea, vomiting, diaphoresis, tachycardia, hypertension, tremor, acute pulmonary edema, cardiac arrhythmia, agitation, violent behavior, and seizure.
Concomitant continuous naloxone IV infusion with parenteral opioid infusions to prevent pruritus may result in increased opioid requirements due to reversal of analgesia. Naloxone by continuous IV infusion should not be mixed with the opioid.
Patient should be monitored for 6 hours (12 hours for methadone overdose) after last naloxone dose or at least 12 hours after naloxone infusion has been stopped.
IV route preferred; IM and SC may have delayed or erratic absorption.
Bolus dose naloxone must always be prescribed to treat inadvertent respiratory depression when opioid infusions are prescribed.
Short duration of action may necessitate repeated doses. May need repeated doses every 20-60 mins or continuous infusion if duration of action of opioid longer than naloxone. Patient should be closely monitored.
Analgesia will also be reversed by naloxone.
Abrupt reversal of opioid effects may induce opioid withdrawal, nausea, vomiting, diaphoresis, tachycardia, hypertension, tremor, acute pulmonary edema, cardiac arrhythmia, agitation, violent behavior, and seizure.
Concomitant continuous naloxone IV infusion with parenteral opioid infusions to prevent pruritus may result in increased opioid requirements due to reversal of analgesia. Naloxone by continuous IV infusion should not be mixed with the opioid.
Patient should be monitored for 6 hours (12 hours for methadone overdose) after last naloxone dose or at least 12 hours after naloxone infusion has been stopped.
References
19, 182, 401, 402, 403, 404
Last Edited
2022-07-28 00:47:54