NALOXONE HYDROCHLORIDE

(nal ox' one)
Narcan
PREGNANCY CATEGORY B

Drug classes
Therapeutic actions
Indications
Contraindications and cautions
Available forms
Dosages
  Adults
  Pediatric patients
  Neonates
Pharmacokinetics
IV facts
Adverse effects
Nursing considerations Assessment
Interventions
Teaching points

 

Drug classes

Narcotic antagonist
Diagnostic agent

Therapeutic actions

Pure narcotic antagonist; reverses the effects of opioids, including respiratory depression, sedation, hypotension; can reverse the psychotomimetic and dysphoric effects of narcotic agonist-antagonists, such as pentazocine.

Indications

• Complete or partial reversal of narcotic depression, including respiratory depression induced by opioids, including natural and synthetic narcotics, propoxyphene, methadone, nalbuphine, butorphanol, pentazocine
• Diagnosis of suspected acute opioid overdose
• Unlabeled uses: improvement of circulation in refractory shock, reversal of alcoholic coma, dementia of Alzheimer or schizophrenic type

Contraindications and cautions

• Contraindicated with allergy to narcotic antagonists.
• Use cautiously with narcotic addiction, CV disorders, pregnancy, lactation.

Available forms

Injection—0.4, 1 mg/mL, neonatal injection—0.02 mg/mL

Dosages

IV administration is recommended in emergencies when rapid onset of action is required.

Adults

•  Narcotic overdose: Initial dose of 0.4–2 mg, IV. Additional doses may be repeated at 2- to 3-min intervals. If no response after 10 mg, question the diagnosis. IM or SC routes may be used if IV route is unavailable.
•  Postoperative narcotic depression: Titrate dose to patient's response. Initial dose of 0.1–0.2 mg IV at 2- to 3-min intervals until desired degree of reversal. Repeat doses may be needed within 1- to 2-hr intervals, depending on amount and type of narcotic. Supplemental IM doses produce a longer-lasting effect.

Pediatric patients

•  Narcotic overdose: Initial dose is 0.01 mg/kg IV. Subsequent dose of 0.1 mg/kg may be administered if needed. May be given IM or SC in divided doses.
•  Postoperative narcotic depression: For the initial reversal of respiratory depression, inject in increments of 0.005–0.01 mg IV at 2- to 3-min intervals to the desired degree of reversal.

Neonates

•  Narcotic-induced depression: Initial dose of 0.01 mg/kg IV, SC, IM. May be repeated as indicated in the adult guidelines.

Pharmacokinetics


Route Onset Duration
IV 2 min 4–6 hr
IM, SC 3–5 min 4–6 hr

Metabolism: Hepatic; T ½: 30–81 min

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

IV facts

Preparation: Dilute in normal saline or 5% dextrose solutions for IV infusions. The addition of 2 mg in 500 mL of solution provides a concentration of 0.004 mg/mL; titrate rate by response. Use diluted mixture within 24 hr. After that time, discard any remaining solution.

Infusion: Inject directly, or titrate rate of infusion based on response.

Incompatibilities: Do not mix naloxone with preparations containing bisulfite, metabisulfite, high molecular weight anions, alkaline pH solutions.

Adverse effects

Adverse effects in Italics are most common; those in Bold are life-threatening.

•  Acute narcotic abstinence syndrome: Nausea, vomiting, sweating, tachycardia, increased BP, tremulousness
•  CNS: Reversal of analgesia and excitement (postoperative use)
•  CV: Hypotension, hypertension, ventricular tachycardia and fibrillation, pulmonary edema (postoperative use)

Nursing considerations Assessment

•  History: Allergy to narcotic antagonists; narcotic addiction; CV disorders; lactation
•  Physical: Sweating; reflexes, pupil size; P, BP; R, adventitious sounds

Interventions

• Monitor patient continuously after use of naloxone; repeat doses may be necessary, depending on duration of narcotic and time of last dose.
• Maintain open airway and provide artificial ventilation, cardiac massage, vasopressor agents if needed to counteract acute narcotic overdose.

Teaching points

• Report sweating, feelings of tremulousness.


Copyright © 2004 Lippincott Williams & Wilkins
Amy M. Karch
2004 Lippincott's Nursing Drug Guide