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Poisoning Information for the Public & Health Care Professionals

Atlantic Canada Poison Centre
Antidote Kit Manual

1-800-565-8161 or 902-470-8161 | atlanticcanadapoisoncentre.ca
Last updated: 02/2020
Pediatric Adult
Last updated: 02/2020
Antidote
Adult

Naloxone Hydrochloride

Narcan®

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Antidote
Adult

Naloxone Hydrochloride

Narcan®

Indications

  • Reversal of opioid-induced respiratory depression, CNS depression, or hypotension.
  • NOTE: Anecdotally, may also reverse coma due to other CNS depressants (clonidine, valproic acid, benzodiazepines, ethanol).

Dosage

  • IV Direct: 0.1 - 0.4 mg initially; repeat (if necessary) at 3 minute intervals.
    • In opioid-dependent patients, start with lower doses (0.04 mg) to avoid withdrawal and titrate to effect.
    • Onset is 0.5 - 2 minutes. Duration of action is variable and may be as short as 45 minutes or as long as 3 - 4 hours, and is partially dependent on the amount, type and route of opioid being reversed.
    • If a cumulative and rapidly titrated dose of more than 10mg does not produce desired effect, assess the need for airway intervention and consider alternate diagnoses.
  • Infusion: Calculate two thirds of the effective IV direct dose and administer that per hour; titrate to effect. Infusions are recommended when repeated IV direct doses are required. Duration of action of opioids is often greater than that of naloxone; repeat bolus doses of naloxone may be necessary during the infusion
  • Alternate Routes of Administration: if intravenous route not available, may administer via the following routes: subcutaneous, intramuscular, intraosseous, intranasal.  Injectable available as 0.4mg or 1mg per mL. Nasal spray available as 2mg or 4mg per 0.1mL. 

Administration

  • IV Direct: Administer over 1 minute. May be given undiluted.
  • Continuous Infusion
    • via large volume pump: Standard dilution is 4 mg/250 mL (0.016 mg/mL) in sodium chloride 0.9% or dextrose 5% in water.
    • via syringe pump: Administer as 0.4mg/mL solution (undiluted). 

Important Monitoring Information 

  • Since the degree of opioid reversal is dependent on the dosage, route and type of opioid that is being reversed, monitoring parameters must be prescribed by the physician.
  • Patients should be monitored for recurrence of symptoms for 4 to 6 hrs after last dose of naloxone or after infusion stopped.
  • Infusions may be weaned in 50% decrements.  Patient should be monitored for recurrence of symptoms during weaning process.

Compatibility, Stability

  • Compatible in sodium chloride 0.9% or dextrose 5% in water for 24 hours.
  • Protect from excessive light and store at room temperature.

Potential Hazards of Administration

  • Severe withdrawal symptoms may be precipitated in opioid dependent patients.
  • Hypersensitivity reactions.
  • Nausea, vomiting, sweating.
  • Use in patients receiving opioids for analgesia may cause reversal of analgesic effects, prolonged blockade of opioid receptors and severe pain that is difficult to control.
  • Possibility of elevated partial thromboplastin time.
  • Hypertension, tachycardia, ventricular arrhythmias and pulmonary edema have been reported in postoperative patients, especially those with pre-exisiting cardiac disease.

Miscellaneous

  • A pure opioid antagonist with little or no agonistic activities.

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