Naloxone Hydrochloride

Indications

Naloxone Hydrochloride is used for: Opioid dependence, Opioid overdosage, Opioid-induced depression

Adult Dose

Oral Opioid dependence Adult: As hydrochloride: 200 mg to 3 g daily. Intravenous Opioid overdosage Adult: As hydrochloride: 0.4-2 mg repeated if necessary at 2-3 min intervals. If there is no response after a total of 10 mg has been given, consider the possibility of overdosage with other drugs. Reduce dose for opioid-dependent patients: 0.1-0.2 mg. IM/SC routes may be used (at IV doses) if IV admin is not feasible. Reversal of central depression from opioid use during surgery Adult: As hydrochloride: 100-200 mcg at intervals of 2-3 minute, titrate dose according to response while maintaining analgesia.

Child Dose

Intravenous Opioid overdosage Child: As hydrochloride: Initially 10 mcg/kg IV followed by 100 mcg/kg IV if necessary. Alternatively, 0.4-0.8 mg IM or SC, repeated as necessary, if IV admin is not feasible. Parenteral Opioid-induced depression in neonates due to obstetric analgesia Child: As hydrochloride: 10 mcg/kg IV, IM or SC repeated at 2-3 min intervals if necessary or 60 mcg/kg as a single IM dose. Intravenous Reversal of central depression from opioid use during surgery Child: As hydrochloride: 5-10 mcg IV at 2-3 min intervals.

Renal Dose

Administration

Contra Indications

Hypersensitivity.

Precautions

Patients physically dependent on opioids, or who have received large doses of opioids (acute withdrawal syndrome may be precipitated). Pregnancy and lactation. Lactation: Not known if distributed in milk; use caution

Pregnancy-Lactation

Pregnancy category: C Lactation: Not known if distributed in milk; use caution

Interactions

Decreased effect of opioid analgesics. Potentially Fatal: Acute withdrawal reaction in physically dependent patients may occur with opioid analgesics. Severe cardiopulmonary effects may occur with cardiotoxic drugs.

Adverse Effects

Side effects of Naloxone Hydrochloride : Occur secondarily to reversal (withdrawal) of narcotic analgesia and sedation. Mental depression, apathy, inability to concentrate, sleepiness, irritability, anorexia, nausea, and vomiting in high oral doses during initial treatment of opiate addiction. Potentially Fatal: Severe cardiopulmonary effects (e.g. hypotension, hypertension, ventricular tachycardia and fibrillation, dyspnoea, pulmonary oedema, cardiac arrest) in postoperative patients, most frequently in those with preexisting CV disease. Recurrence of respiratory depression in long-acting opioids.

Mechanism of Action

Naloxone is a pure opioid antagonist that acts competitively at opioid receptors.