Brand Name
Narcan
Class and Category
Chemical class: Thebaine derivative
Therapeutic class: Opioid antagonist
Pregnancy category: B
Indications and Dosages
To treat known or suspected opioid overdose
I.V. INJECTION
Adults and children age 5 and over weighing more than 20 kg (44
lb). 0.4 to 2 mg repeated every 2 to 3 min, p.r.n. If no response
after 10 mg, patient may not have opioid-induced respiratory depression.
Infants and children under age 5. 0.01 mg/kg
as a single dose; if no improvement, another 0.1 mg/kg, as prescribed.
Or, 0.1 mg/kg repeated every 2 to 3 min, as needed
I.V., I.M., OR SUBCUTANEOUS INJECTION
Neonates. 0.01 mg/kg repeated I.V. every 2 to 3 min, as
prescribed, until desired response occurs. Or, initial I.V. dose of 0.1 mg/kg.
To treat postoperative opioid-induced respiratory
depression
I.V. INJECTION
Adults and adolescents. Initial: 0.1 to 0.2
mg every 2 to 3 min until desired response occurs. Additional doses given every
1 to 2 hr, if needed, based on patient response.
Children. Initial: 0.005 to 0.01 mg every 2 to
3 min until desired response occurs. Additional doses given every 1 to 2 hr, if
needed, based on patient response.
To reverse opioid-induced asphyxia
I.V. , I.M., OR SUBCUTANEOUS INJECTION
Neonates. Initial: 0.01 mg/kg every 2 to 3 min
until desired response occurs. Additional doses given every 1 to 2 hr, if needed,
based on patient response.
As adjunct to treat hypotension caused by septic shock
I.V. INFUSION OR INJECTION
Adults. 0.03 to 0.2 mg/kg over 5 min followed by continuous infusion of
0.03 to 0.3 mg/kg/hr for 1 to 24 hr, as needed, based on patient response.
Route Onset Peak Duration
I.V. 1–2 min 5–15 min 45 min or longer
I.M/SubQ 2–5 min 5–15 min 45 min or longer
Mechanism of Action
Briefly and competitively antagonizes mu, kappa, and sigma
receptors in the CNS, thus reversing analgesia, hypotension, respiratory depression,
and sedation caused by most opioids.Mu receptors are responsible for analgesia,
euphoria, miosis, and respiratory depression. Kappa receptors are responsible
for analgesia and sedation. Sigma receptors control dysphoria and other
delusional states.
Incompatibilities
Don’t mix naloxone with any other solution unless you verify the
drugs are compatible; drug is incompatible with alkaline, bisulfite, and
metabisulfite solutions.
Contraindications
Hypersensitivity to naloxone or its components
Interactions
DRUGS
butorphanol, nalbuphine, pentazocine: Reversal
of these drugs’ analgesic and adverse effects
opioid analgesics: Reversal of these drugs’ analgesic
and adverse effects, possibly withdrawal symptoms in opioid-dependent patients
Adverse Reactions
CNS: Excitement, irritability, nervousness, restlessness, seizures,
tremor, violent behavior
CV: Hypertension (severe), hypotension, ventricular fibrillation,
ventricular tachycardia
GI: Nausea, vomiting
RESP: Pulmonary edema
SKIN: Diaphoresis
Other:Withdrawal symptoms
Nursing Considerations
• Keep resuscitation equipment readily available during naloxone
administration.
• Administer drug by I.V. route whenever possible.
• Give repeat doses as prescribed, depending on patient’s
response.
• Anticipate that rapid reversal of opioid effects can cause
diaphoresis, nausea, and vomiting.
WARNING Watch for withdrawal symptoms, especially
when giving naloxone to opioiddependent patient. Symptoms may include abdominal
cramps, anorexia, anxiety, backache, bone or joint pain, confusion, depression,
diaphoresis, dysphoria, erythema, fear, fever, irritability, labile blood pressure
and pulse, lacrimation, muscle spasms, myalgia, mydriasis, nasal congestion, nausea,
opioid craving, piloerection, restlessness, rhinorrhea, sensation of crawling
skin, sleep disturbances, tremor, uneasiness, vomiting, and yawning.
• Expect patient with hepatic or renal dysfunction to have
increased circulating blood naloxone level.
PATIENT TEACHING
• Inform patient or family that naloxone will reverse
opioid-induced adverse reactions.
• Urge opioid-dependent patient to seek drug rehabilitation.
