Generic Drug Name: naloxone
Brand Names: Narcan, Evzio
Classification:
Therapeutic: antidotes (for opioids)
Pharmacologic: opioid antagonists
Indications:
- Reversal of CNS and respiratory depression due to opioid overdose
Mechanism of Action:
Competitively blocks the effects of opioids, primarily CNS and respiratory depression, without producing any effects of the opioids
Expected Response: reverse signs of excess opioids
Common Adult Doses: (ALWAYS CHECK YOUR ORDERS)
For post-op opioid-induced respiratory depression:
IV (Adults): 0.02-0.2 mg every 2-3 minutes until response obtained. Repeat every 1-2 hours if needed.
IV (Children): 0.01 mg/kg every 2-3 minutes until response obtained. Repeat every 1-2 hours if needed.
IM, IV, SubQ (Neonates): 0.01 mg/kg every 2-3 minutes until response obtained. Repeat every 1-2 hours if needed.
For opioid-induced respiratory depression during chronic use (>1 week):
IV, IM, SubQ (Adults >40kg): 20-40 mcg (0.02-0.04 mg) given every minute boluses or as infusion to titrate and improve respiratory function without reversing analgesia.
IV, IM, SubQ (Adults and children <40kg): 0.005-0.02 mg/dose given every minute boluses or as infusion to titrate and improve respiratory function without reversing analgesia.
Overdose of opioids:
IV, IM, SubQ (Adults): (if not opioid dependent) 0.4 mg (10 mcg/kg) every 2-3 minutes until resolved. (if opioid dependent) 0.1-0.2 mg every 2-3 minutes.
IM, SubQ (Adults and children): Evzio – 0.4 mg every 2-3 minutes until emergency medical assistance arrives
IV, IM, SubQ (Children >5 years or >20kg): 2 mg/dose every 2-3 minutes
IV, IM, SubQ (Infants up to 5 years or 20kg): 0.1 mg/kg every 2-3 minutes
Intranasal (Adults and children): 1 spray (2 mg or 4 mg) in one nostril every 2-3 minutes, alternating nostrils
Contraindications:
- Hypersensitivity to naloxone
Use cautiously in:
- Cardiovascular disease
- Patient’s physically dependent on opioids (may cause withdrawal)
- In pregnant patients dependent on opioids as fetus can be affected as well
- Lactating mothers
- Pediatrics – may cause withdrawal syndrome in neonates of dependent mothers
Side Effects:
Common
- Nausea
- Vomiting
- Hypertension
- Hypotension
Life-Threatening
- Ventricular arrhythmias
Nursing Considerations:
Assessment
- Monitor respiratory rate, rhythm, and depth; pulse and ECG; BP; level of consciousness frequently for 3-4 hours after peak of naloxone.
- Patients taking opioids >1 week are extremely sensitive to naloxone. Dilute and administer slowly.
- Assess patients for level of pain after administration as analgesia is reversed.
- Assess patients for signs and symptoms of acute opioid withdrawal (vomiting, restlessness, abdominal cramps, increased BP and temperature). Severity is different for each person but can start within minutes to 2 hours.
- Lack of improvement could indicate other issues that need to be explored.
Nursing Diagnoses
- Ineffective breathing pattern (Indications)
- Ineffective coping (Indications)
- Acute pain
Implementation
- Do not confuse naloxone with Lanoxin (Digoxin). Do not confuse Narcan (naloxone) with Norcuron (vecuronium).
- Have resuscitation equipment nearby: oxygen, vasopressors, and mechanical ventilator.
- Doses should be titrated carefully in post-op patients to avoid interference with pain control.
- Evzio: a take-home naloxone auto-injector that patients, family members, and others can have closely in case an overdose occurs. Has visual and voice instructions. Inject in to upper outer thigh.
- Intranasal: If being used, inform family or others to call 911 for emergency support.
- IV doses: Administer undiluted for suspected overdoses. Administer diluted with sterile water if respiratory depression noted.
- Educate patient to
- As medication becomes effective, explain why the naloxone was given and the effects it is having.
- Intranasal dose: instruction family or caregivers on correct administration technique.
- Evzio: explain purpose and instructions. Inform to call 911 for emergency support.
Expected Outcomes
- Adequate ventilation following excess opioids
- Alertness without significant pain or withdrawal symptoms.
Reference
Vallerand, A. H. & Sanoski, C. A. (2019). Davis’s drug guide for nurses. (16th ed., pp. 890-893). F.A. Davis Company.
