Naloxone

1. NALOXONE AS OPIOID ANTAGONISTS
PREPARED BY:
MIDYA SHERZAD HUSSEIN

2. • Opioid antagonist: blocks the effects of opioids in the brain, restores normal breathing
when given to a person who has overdosed
• Administration: intravenous, intramuscular, subcutaneous, or intranasal
• Formulations: milliliter vials, auto-injector, nasal spray
• Onset: 2-5 min depending on administration
• Duration: 30-90 min depending on administration
• Dosage (adults): initial dose 0.4-4mg (every 2-3 min up to 10mg) or until improvement in
respiratory function
Pediatric: 0.01 mg/kg IV; if desired response is not obtained, may give 0.1 mg/kg IV
• Storage: room temp (~59oF to ~77oF), protect from light
Introduction to Naloxone

3. Opioid misuse and overdose are a public health matter as it is linked to raised rate of morbidity and mortality, Naloxone
was first approved for use in the United States in 1971. It remains available as a solution for injection in generic forms
and under the brand name Narcan, which is 0.3 mg/kg of a 10 mg/ml solution and this opioid antagonist, used clinically
for decades, is now becoming accessible in the houses of those with potential for opioid overdose.
Opioid overdose can occur when a patient confuses the directions for use, accidentally consumes an
extra dose, misuses a prescription opioid or a forbidden drug like heroin. Likewise, if a person takes
opioid medications recommended for someone else, or if a person combines opioid with other
medications, alcohol, or over-the-counter drugs.
Opioid Overdose

4. Click to add text
Naloxone attaches to the same
brain receptors as opioids, but
more
strongly. Naloxone kicks off the
opioids and “takes over”
the receptors, causing opioid
withdrawal. This
restores breathing and
consciousness in about 2-5
minutes.
Mechanism of Action

5. How to Recognize an Opiate
Overdose Person
• unconscious, and cannot be woken -
UNROUSABLE and does not respond to noise
or touch (e.g. shoulder shake)
• CYANOSIS – BLUE tinge to lips, tip of nose, eye
bags, finger tips or nails
• Not breathing at all or taking slow/shallow or
infrequent breaths - DEEP SNORING / RASPING
RASPING sounds
• PIN POINT pupils

6. Follow the S.A.V.E. M.E. steps:
S – Stimulate: Poke, shout. Unresponsive? Call 911.
A – Airway: Open their airway. Tilt their neck back
gently.
V – Ventilate: Give 1 breath every 5 seconds.
E – Evaluate: Are they breathing?
M – Muscular Injection: Inject 1mL of naloxone into a
muscle. Keep giving breaths.
E – Evaluate and support: If they don’t respond after 3-
5 minutes, give another naloxone injection. Continue
giving breaths.

7. How to use naloxone
• Addition of 2mg of naloxone to 500ml of normal saline (0.9%) or to 500ml of 5% dextrose in water or in saline will
provide a concentration of 4 micrograms/ml (0.004mg/ml) for 24 hours.
• For adults, an initial dose of 400 to 2000 micrograms (0.4mg to 2mg) of naloxone may be given intravenously and may,
may, if required, be repeated at 2 to 3 minute intervals. The diagnosis of opioid-related toxicity should be reconsidered
reconsidered if there is still failure to respond after a total of 10mg of naloxone has been administered. If intravenous
administration is impracticable, naloxone may be administered by the intramuscular or subcutaneous route
• For children, the usual initial dose is 10 micrograms (0.01mg) per kg body weight, intravenously. A subsequent dose of
100 micrograms (0.1mg) per kg body weight may be used if required. Naloxone may be administered by intravenous
infusion, if appropriate.

8. For IM
Use a long needle (1 to 1 ½ inches) called an intramuscular needle (IM). These needles can
be located at either needle exchange programs or pharmacies. Now, pop off the orange top
vial of naloxone. From the vial, draw up to 1cc of naloxone into the syringe. 1cc=1 mL=100 u
• Inject into a muscle
•Side of thigh area or upper arm.​
• Hold needle 90 degree above skin​
• Insert needle into muscle​
• Slowly and Steadily push plunger as directed

9. •Do rescue breathing for a few quick breaths if the person is not breathing.
•Use a long needle: 1 – 1 ½ inch (called an IM or intramuscular needle)- needle exchange programs and
pharmacies have these needles.
•Pop off the orange top vial
•Draw up 1cc of naloxone into the syringe 1cc=1mL=100u.
•Inject into a muscle – thighs, upper, outer quadrant of the butt, or shoulder are best.
•Inject straight in to make sure to hit the muscle.
•If there isn’t a big needle, a smaller needle is OK and inject under the skin, but if possible it is better to
inject into a muscle.
•After injection, continue rescue breathing 2-3 minutes.
•If there is no change in 2-3 minutes, administer another dose of naloxone and continue to breathe for
them. If the second dose of naloxone does not revive them, something else may be wrong—either it has
been too long and the heart has already stopped, there are no opioids in their system, or the opioids are
unusually strong and require more naloxone (can happen with Fentanyl, for example).
Injectable Naloxone

11. Naloxone Side Effects
 Acute pain
 Body aches
 Diarrhea
 Increased heart rate
 Fever
 Runny nose
 Sneezing
 Goose bumps
 Sweating
 Nausea and vomiting
 Nervousness, anxiety
 Restlessness or irritability
 Shivering or trembling
 Stomach cramping
 Weakness
 Increased blood pressure

12. Nursing assessment