Yes

Antidote

Dental: Reverses CNS and respiratory depressant effects of fentanyl and meperidine during I.V. conscious state

Medical:

Complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids, including propoxyphene, methadone, and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, and butorphanol

Diagnosis of suspected opioid tolerance or acute opioid overdose

Adjunctive agent to increase blood pressure in the management of septic shock

Unlabeled use: PCP and alcohol ingestion

B

Hypersensitivity to naloxone or any component

Due to an association between naloxone and acute pulmonary edema, use with caution in patients with cardiovascular disease or in patients receiving medications with potential adverse cardiovascular effects (eg, hypotension, pulmonary edema or arrhythmias). Excessive dosages should be avoided after use of opiates in surgery, because naloxone may cause an increase in blood pressure and reversal of anesthesia; may precipitate withdrawal symptoms in patients addicted to opiates, including pain, hypertension, sweating, agitation, irritability; in neonates: shrill cry, failure to feed. Recurrence of respiratory depression is possible if the opioid involved is long-acting; observe patients until there is no reasonable risk of recurrent respiratory depression.

Cardiovascular: Hypertension, hypotension, tachycardia, ventricular arrhythmias, cardiac arrest

Central nervous system: Irritability, anxiety, narcotic withdrawal, restlessness, seizures

Gastrointestinal: Nausea, vomiting, diarrhea

Neuromuscular & skeletal: Tremulousness

Respiratory: Dyspnea, pulmonary edema, runny nose, sneezing

Miscellaneous: Diaphoresis

Naloxone is the drug of choice for respiratory depression that is known or suspected to be caused by an overdose of an opiate or opioid

Decreased effect of narcotic analgesics

Protect from light; stable in 0.9% sodium chloride and D₅W at 4 mcg/mL for 24 hours; do not mix with alkaline solutions

Pure opioid antagonist that competes and displaces narcotics at opioid receptor sites

Onset of effect: Endotracheal, I.M., S.C.: Within 2-5 minutes; I.V.: Within 2 minutes

Duration: 20-60 minutes; since shorter than that of most opioids, repeated doses are usually needed

Distribution: Crosses the placenta

Metabolism: Primarily by glucuronidation in the liver

Half-life: Neonates: 1.2-3 hours; Adults: 1-1.5 hours

Elimination: In urine as metabolites

I.M., I.V. (preferred), intratracheal, S.C.:

Opiate intoxication:

Birth (including premature infants) to 5 years or <20 kg: 0.1 mg/kg; repeat every 2-3 minutes if needed; may need to repeat doses every 20-60 minutes

>5 years or greater than or equal to 20 kg: 2 mg/dose; if no response, repeat every 2-3 minutes; may need to repeat doses every 20-60 minutes

Continuous infusion: I.V.: Children and Adults: If continuous infusion is required, calculate dosage/hour based on effective intermittent dose used and duration of adequate response seen, titrate dose 0.04-0.16 mg/kg/hour for 2-5 days in children, up to 0.8 mg/kg/hour in adults; alternatively, continuous infusion utilizes 2/3 of the initial naloxone bolus on an hourly basis; add 10 times this dose to each liter of D₅W and infuse at a rate of 100 mL/hour; 1/2 of the initial bolus dose should be readministered 15 minutes after initiation of the continuous infusion to prevent a drop in naloxone levels; increase infusion rate as needed to assure adequate ventilation

Narcotic overdose: Adults: I.V.: 0.4-2 mg every 2-3 minutes as needed; may need to repeat doses every 20-60 minutes, if no response is observed after 10 mg, question the diagnosis. Note: Use 0.1-0.2 mg increments in patients who are opioid dependent and in postoperative patients to avoid large cardiovascular changes.

No data reported

Endotracheal: Dilute to 1-2 mL with normal saline

I.V. push: Administer over 30 seconds as undiluted preparation

I.V. continuous infusion: Dilute to 4 mcg/mL in D₅W or normal saline

Respiratory rate, heart rate, blood pressure

No information available to require special precautions

No effects or complications reported

If patient is responsive, instructions are individualized. This drug can only be administered I.V. Report difficulty breathing, palpitations, or tremors. Breast-feeding precautions: Breast-feeding is not recommended.

The use of neonatal naloxone (0.02 mg/mL) is no longer recommended because unacceptable fluid volumes will result, especially to small neonates; the 0.4 mg/mL preparation is available and can be accurately dosed with appropriately sized syringes (1 mL)

Injection, as hydrochloride: 0.4 mg/mL (1 mL, 2 mL, 10 mL); 1 mg/mL (2 mL, 10 mL)

Injection, neonatal, as hydrochloride: 0.02 mg/mL (2 mL)

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Hantson P, Evenepoel E, Ziade D, et al, "Adverse Cardiac Manifestations Following Dextropropoxyphene Overdose: Can Naloxone Be Helpful?" Ann Emerg Med, 1995, 25(2):263-6.

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