I. See Also

II. Indications: Narcotic Overdose management

  1. Respiratory Depression (Hypoxia, apnea)
  2. Severe Sedation (e.g. comatose)

IV. Findings: Symptoms and Signs

  1. Altered Level of Consciousness (CNS depression or Sedation)
    1. Coma
    2. Lethargy
    3. Stupor
  2. Hypotension
  3. Miosis (except Demerol which causes Mydriasis)
  4. Pulmonary edema
  5. Respiratory depression
  6. Seizures

V. Precautions

  1. Close monitoring must be continued after antidote
    1. Narcotic half-life might exceed that of Naloxone
  2. Consider Very Low Dose Naloxone Protocol
    1. Indicated for Cancer Pain or Chronic Pain (prevents severe rebound pain)

VI. Differential Diagnosis: Suspected Opioid Overdose not reversing with Naloxone

  1. Clonidine Overdose
  2. Drugs of Abuse often have very high potency
    1. Krokodil (use Naloxone 2 mg)
    2. Fentanyl derivative (may require Naloxone up to 10 mg )

VII. Management: General

  1. Naloxone at doses below
  2. Consider for long acting Opioids (Oxycontin, MS Contin, Methadone, Zohydro)
    1. Naloxone continuous infusion
    2. Nalmefene (Revex)

VIII. Management: Naloxone (Narcan)

  1. Adults
    1. Initial
      1. No respiratory depression: 0.1 to 0.4 mg IV or IM
      2. Respiratory depression: 1 to 2 mg IV or IM
    2. Next, if no response or incomplete response
      1. Give 2 mg IV or IM every 3-5 minutes to a total of 10-20 mg
    3. Infusion
      1. Naloxone 2 mg in 500 ml D5W or NS (0.004 mg/ml) titrating to response
  2. Children
    1. Initial
      1. No respiratory depression: 0.01 mg/kg IV or IM
      2. Respiratory depression: 0.1 mg/kg IV or IM
    2. Next, if no response or incomplete response
      1. Give 0.1 mg/kg IV or IM

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