Naloxone is indicated for the complete or partial reversal of life-threatening central nervous system/respiratory depression induced by opioids.
Key treatment points
- Review treatment goals.
- Patients should meet all of the following criteria before naloxone is administered: 1) depressed mental status (difficult to arouse or unarousable); and 2) shallow respirations or a rate of less than 8/minute, associated with evidence of inadequate ventilation.
- Stop opioid administration.
- Dilute 0.4 mg naloxone (one ampule) with normal saline to a total volume of 10 ml (1 ml = 0.04 mg naloxone).
- Remind the patient to breathe; though narcotized, patients report hearing concerned staff while being unable to open their eyes or respond.
- Administer 1 ml IV (0.04 mg) q1min until the patient is responsive. A typical response is noted after 2-4 ml with deeper breathing and greater level of arousal.
- If the patient does not respond to a total of 0.8 mg naloxone (2 amps), consider other causes of sedation and respiratory depression.
- The duration of action of naloxone is considerably shorter than the duration of action of most short-acting opioids. A repeat dose of naloxone, or even a continuous naloxone infusion, may be needed.
- Wait until there is sustained improvement in consciousness before restarting opioids at a lower dose.
See reference for details.
Adapted from Dunwoody C and Arnold R. Palliative Care Network of Wisconsin. Fast facts and concepts #39. Using naloxone. Internet. Accessed on January 25, 2016.