Naloxone prevents opioids from binding to opioid receptors and displaces opioids from opioid receptors (Nelson & Howland, 2019; Go, 2018). Naloxone has been reported to reverse the toxic effects of clonidine overdose and overdose effects of other drugs (Go, 2018).
Naloxone can be given IV, IM, intra-nasally, continuous infusion, and other routes (Go, 2018).
Naloxone is intended to reverse respiratory depression and restore adequate ventilation, not to restore full consciousness. Use the lowest dose that will safely do this (Nelson & Olsen, 2019).
The dose is 0.4 mg to 2 mg IV (Go, 2018), but a lower starting dose like 0.04 mg is advisable if the patient is opioid-dependent (Nelson & Howland, 2019; Go, 2018).
Doses can be given at 2-to-3-minute intervals as needed (Go, 2018); if a total of 10 mg has been given without a response, likely, the patient is not opioid toxic (Nelson & Olsen, 2019).
If the patient requires multiple naloxone doses, a continuous naloxone infusion is helpful. Use two-thirds of the amount that restored ventilation and give this amount every hour (Nelson & Olsen, 2019; Go, 2018).
Naloxone is contraindicated in patients who have a hypersensitivity to the drug (Go, 2018).
Adverse effects include precipitation of opioid withdrawal, unmasking the toxic effects of co-ingestants, pulmonary edema, and ventricular fibrillation (Elkattaway et al., 2021; Go, 2018). Pulmonary edema and ventricular fibrillation are rare adverse effects (Elkattaway et al., 2021).
Precipitation of opioid withdrawal can cause a catecholamine surge. This catecholamine surge and hypercapnia from the opioid can cause serious signs and symptoms, and these can be avoided by ventilating the patient before giving naloxone (Nelson & Howland, 2019).