Naloxone
Liverpool Hospital Emergency Department
Indications:
- Opiate intoxication with CNS and Respiratory depression (RR <8)
- Can consider in Clonidine OD
Formulation:
- 400mcg/ml – ampule
- Infusion – 4mg Naloxone in 100ml saline
Dosage and Administration: Caution advised with opiate dependence
- Bolus IV: 400mcg naloxone in 10ml syringe –with saline up to total 10ml. (40mcg/ml)
- Provide incremental dosage increases every 2-3 minutes double dose if no response as demonstrated below to max of 10mg
- 40mcg (1ml)
- 80mcg (2ml)
- 120mcg (3ml)
- 160mcg (4ml)
- 200mcg (5ml)
If unable to obtain IV access consider: doses up to 2000mcg IM may be needed and IN naloxone can come in a 1.8mg/ml nasal spray
- Infusion: start at 2/3 dose of initial dose (required in the first hour) then titrate to below end points e.g. if 600mcg was required in the first hour, dose commence at 400mcg/hr.
- Continue in HDU
- Commence if multiple doses or redosing is required
Alternative modes of delivery
- 400mcg IM
- 400mcg Intranasal
- 400mcg Neb
Paediatric dosing:
- 10mcg/kg IV bolus
Response is indicated by:
- Increased RR (age appropriate) adults >8-10 when asleep and saturations >92% on RA
- Improved conscious state to allow for airway protection
Side Effects
- Opiate – Withdrawal
- Aggression/ agitation
- If full withdrawal – catecholamine surge – Can precipitate ACS/APO/ stroke
Pit Falls
- One dose of naloxone is usually sufficient for short acting opiates e.g. heroin o Long acting opiates will likely need an infusion e.g. methadone / oxycodone / poor renal excretion
- Avoid in opiate dependent individuals unless signs of respiratory depression < 8 or GCS <12
- Titrate to end point – rousable and adequate RR – avoids full reversal
- Must observe for 2hrs post administration.
- Larger doses of naloxone may be required for Buprenorphine or synthetic opiates