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.
Side 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.
Mode of Action
Naloxone is a pure opioid antagonist that acts competitively at opioid receptors.