NALOXONE HYDROCHLORIDE

(nal-ox'one)

Narcan
Classifications: narcotic (opiate) antagonist;
Therapeutic: narcotic antagonist
Pregnancy Category: C

Availability

0.02 mg/mL, 0.4 mg/mL, 1 mg/mL injection

Action

Analog of oxymorphone. A "pure" narcotic antagonist, essentially free of agonistic (morphine-like) properties. Thus, it produces no significant analgesia, respiratory depression, psychotomimetic effects, or miosis when administered in the absence of narcotics and possesses more potent narcotic antagonist action.

Therapeutic Effect

Reverses the effects of opiates, including respiratory depression, sedation, and hypotension.

Uses

Narcotic overdosage; complete or partial reversal of narcotic depression including respiratory depression induced by natural and synthetic narcotics and by pentazocine and propoxyphene. Drug of choice when nature of depressant drug is not known and for diagnosis of suspected acute opioid overdosage.

Unlabeled Uses

Shock and to reverse alcohol-induced or clonidine-induced coma or respiratory depression.

Contraindications

Hypersensitivity to naloxone, naltrexone, nalmefene; respiratory depression due to nonopioid drugs; substance abuse; pregnancy (category C).

Cautious Use

Neonates and children; known or suspected narcotic dependence; brain tumor, head trauma, increased ICP; history of substance abuse; cardiac irritability; seizure disorders; lactation.

Route & Dosage

Opiate Overdose
Adult: IV 0.4–2 mg, may repeat q2–3min up to 10 mg if necessary
Child: IV 0.01–0.1 mg/kg, may repeat q2–3min up to 10 mg if necessary
Neonate: IV/SC/IM 0.01 mg/kg, may repeat q2–3min

Postoperative Opiate Depression
Adult: IV 0.1–0.2 mg, may repeat q2–3min for up to 3 doses if necessary
Child: IV 0.005–0.01 mg/kg, may repeat q2–3min up to 3 doses if necessary

Administration

Intravenous

PREPARE: Direct: May be given undiluted. IV Infusion: Dilute 2 mg in 500 mL of D5W or NS to yield 4 mcg/mL (0.004 mg/mL).

ADMINISTER: Direct: Give bolus dose over 10–15 sec. IV Infusion: Adjust rate according to patient response.

INCOMPATIBILITIES Y-site: Amphotericin B cholesteryl complex.

Use IV solutions within 24 h.
Store at 15°–30° C (59°–86° F), protect from excessive light.

Adverse Effects (≥1%)

Body as a Whole: Reversal of analgesia, tremors, hyperventilation, slight drowsiness, sweating. CV: Increased BP, tachycardia. GI: Nausea, vomiting. Hematologic: Elevated partial thromboplastin time.

Interactions

Drug: Reverses analgesic effects of narcotic (opiate) agonists and narcotic (opiate) agonist-antagonists.

Pharmacokinetics

Onset: 2 min. Duration: 45 min. Distribution: Crosses placenta. Metabolism: In liver. Elimination: In urine. Half-Life: 60–90 min.

Nursing Implications

Assessment & Drug Effects

Observe patient closely; duration of action of some narcotics may exceed that of naloxone. Keep physician informed; repeat naloxone dose may be necessary.
May precipitate opiate withdrawal if administered to a patient who is opiate dependent.
Note: Narcotic abstinence symptoms induced by naloxone generally start to diminish 20–40 min after administration and usually disappear within 90 min.
Monitor respirations and other vital signs.
Monitor surgical and obstetric patients closely for bleeding. Naloxone has been associated with abnormal coagulation test results. Also observe for reversal of analgesia, which may be manifested by nausea, vomiting, sweating, tachycardia.

Patient & Family Education

Report postoperative pain that emerges after administration of this drug to physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(100)