View source for Naloxone

==General==
*Type: [[Opioid]] antagonists, [[antidote]]
*Dosage Forms:
*Common Trade Names: Narcan

==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)<ref>Naloxone. In: ''Lexi-Drugs''. UpToDate Inc; 2025. Accessed September 30, 2025. https://www.uptodate.com/contents/naloxone-drug-information</ref>

==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==
*[[Drug Ratings in Pregnancy|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]]<ref>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.</ref>
*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)<ref>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</ref>.


==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''

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==See Also==
*[[Opioid toxicity]]
*[[Opioid withdrawal]]

==References==
<references/>

[[Category:Pharmacology]]
[[Category:Toxicology]]