Naloxone
General
Adult Dosing
Opioid toxicity
- Bolus (May repeat q3min up to max dose 10mg)
- Apneic or near-apneic - 2mg IV
- Opioid-naive with minimal respiratory depression - 0.4mg IV
- Opioid-dependent with minimal respiratory depression - 0.05mg IV
- Infusion
- Only give if the patient responded to the bolus and required repeat administration
- Step 1: Determine the "wake-up dose" or bolus required to wake the pt
- Step 2: Give 2/3 of the "wake-up dose" per hr; mix in 1L D5W
- Intranasal
- Pre-mixed nasal spray: 3,4, or 8 mg (1 spray) in one nostril. May repeat q 2-3 minutes if no response
- IV solution: 2 mg (1 mg each nostril using atomizer)[1]
Pediatric Dosing
- Full reversal (overdose or intoxication)
- IV/IO: 0.1 mg/kg (max 2 mg). Repeat every 2 to 3 minutes as needed
- Titrated correction of respiratory depression from therapeutic opioid
- IV/IM/SUBQ: 0.005 to 0.01mg/kg IV every 2 to 3 minutes as needed to desired degree of reversal
Special Populations
- Pregnancy Rating: C
- Lactation: insufficient data
- Renal Dosing: No dose adjustment
- Hepatic Dosing: No dose adjustment
Contraindications
- Allergy to class/drug
Adverse Reactions
- Opioid withdrawal
- Non-cardiogenic pulmonary edema[2]
- Serious complications are rare
Pharmacology
- Metabolism: hepatic
- Excretion: renal
- Mechanism of Action: opioid antagonist (competes for mu receptor binding sites, displacing opioid)
- Onset of action - 1-2min
- Duration of action - 20-90min (may be less than that of the ingested opioid)
- For this reason many hospital algorithms call for ~3 hours of ED observation prior to discharge
- Some small studies have called for decreasing this time frame to 1 hour but there are often adverse events in a significant proportion of these patients (one study showed that 15% of patients had adverse events such as need for supplemental oxygen after attempting discharge at 1 hour)[3].
See Also
References
- ↑ Naloxone. In: Lexi-Drugs. UpToDate Inc; 2025. Accessed September 30, 2025. https://www.uptodate.com/contents/naloxone-drug-information
- ↑ Mechanism for Naloxone-Related Pulmonary Edema in Opiate or Opioid Overdose Reversal. August 2015. EBM Consult. https://www.ebmconsult.com/articles/mechanism-naloxone-related-pulmonary-edema-opiate-opioid-overdose-reversal.
- ↑ Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study Clemency, B.M., et al, Acad Emerg Med 26(1):7, January 2019