Naloxone [1 vial $6.60] ADMINISTRATION ROUTES:
ALTERNATIVE NAMES: Narcan
ICU INDICATIONS: 1. Reversalofnarcoticrespiratorydepressionandcoma
PRESENTATION AND ADMINISTRATION:
0.4mg in 1ml vial For bolus injection, usually dilute one vial in 10-20ml of compatible IV fluid For continuous infusion, add 2mg to 500ml of compatible IV fluid to give a solution with a concentration of 4mcg/ml. Discard any solution not used within 24 hours of preparation Compatible with the following IV fluids: Normal saline 5% dextrose Water for injection Store at room temperature
For reversal of post-operative respiratory depression and coma: 20-40mcg IV PRN For opioid overdose: 40-400mcg IV PRN Infusion: If an infusion is required, commence the infusion with an hourly infusion rate calculated as 2/3rd of the total bolus dose given to achieve the desired opioid reversal effect
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
For post-operative respiratory depression or over-sedation, give 0.002mg/kg/dose (i.e. dilute 0.4mg to 20ml and then give 0.1ml/kg/dose). Repeat every 2 minutes x4 if required, then commence infusion by adding 0.3mg/kg to 30ml 5% dextrose and running at 0-1ml/hr (0.01mg/kg/hr).
For opiate overdose, give 0.01mg/kg (max 0.4mg) (i.e. dilute 0.4mg to 10ml and give 0.25ml/kg/dose). Repeat every 2 minutes x4 if required, then commence infusion by adding 0.3mg/kg to 30ml 5% dextrose and running at 0-1ml/hr (0.01mg/kg/hr).
CLINICAL PHARMACOLOGY: Naloxone hydrochloride, is a narcotic antagonist. Naloxone prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension.
CONTRAINDICATIONS: 1. hypersensitivitytonaloxone
304WARNINGS Naloxone injection should be administered cautiously to persons including newborns of mothers who are known or suspected to be physically dependent on opioids. In such cases, an abrupt and complete reversal of narcotic effects may precipitate an acute abstinence syndrome. Naloxone is not effective against respiratory depression due to non-opioid drugs. Reversal of buprenorpinephrine-induced respiratory depression may be incomplete.
In addition to naloxone injection, other resuscitative measures, such as maintenance of a free airway, artificial ventilation, cardiac massage and vasopressor agents should be available and employed, when necessary, to counteract acute narcotic poisoning. Several instances of hypotension, hypertension, ventricular tachycardia and fibrillation, and pulmonary edema have been reported. These have occurred in postoperative patients most of whom had pre-existing cardiovascular disorders or received other drugs which may have similar adverse cardiovascular effects. Although a direct cause and effect relationship has not been established, naloxone injection should be used with caution in patients with pre-existing cardiac disease or patients who have received potentially cardiotoxic drugs.
No tests in addition to usual ICU tests are indicated
Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS FOR THE ICU Reverses opioid effects!
ADVERSE REACTIONS Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness. In post-operative patients, larger than necessary dosages of naloxone may result in significant reversal of analgesia.
Hypotension, hypertension, ventricular tachycardia and fibrillation, and pulmonary oedema have been associated with the use of naloxone postoperatively