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Naloxone (Narcan) Opiate antagonist

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Much smaller doses are given to reverse opiate excess in those on palliation as sudden complete reversal may cause severe pain. It is the emergency antidote for overdoses caused by heroin and other opiates or opioids (such as methadone, morphine and fentanyl). The initial dose is usually 0.4-2 mg Naloxone hydrochloride in Adults. Reversal of buprenorphine-induced respiratory depression may be incomplete.

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Caution: Check BNF or equivalent for UpToDate prescribing advice

Mode of action

Opiate antagonist

Indication/Dose (Adults)

Name	Starting Dose	Frequency	Route
Naloxone (Opioid toxicity)	400 microgrammes (0.4 mg)	stat which may be repeated up to 2-4 mg. larger doses may be given	IV
Naloxone (opioid toxicity)	400 microgrammes (0.4 mg)	stat which may be repeated	IM in multiple sites deltoid or anterolateral thigh
Naloxone (opioid toxicity in palliation)	100-200 microgrammes (0.1-0.2 mg)	stat which may be repeated	IV/IM slowly. Full reversal avoided if this would cause severe pain and withdrawal
Naloxone (opioid toxicity )	1.8 mg	stat which may be repeated	Nasal which may be repeated after 2-3 minutes

Cautions

Naloxone 400 micrograms/ml must be given with caution to patients who have received high doses of opioids or are physically dependent on opioids.
Too rapid reversal of the opioid effect can cause an acute withdrawal syndrome in such patients.
Hypertension, cardiac arrhythmias, pulmonary oedema and cardiac arrest have been described.

Side effects

Arrhythmias even VT in elderly receiving naloxone.
Dizziness; headache; hypertension; hypotension; nausea; vomiting

References

Naloxone in BNF

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