PRACTICALITIES

Administration

• Boluses; 400mcg naloxone in 0.9% N/saline up to 10ml; 40mcg/ml, titrate in 40mcg boluses, titrate to clinical effect at 2-3 minute intervals, commence low dose to avoid reversal of opioid analgesic effect unless clinically warranted
• Infusion; 2mg naloxone in 100ml N/saline; 20mcg/ml, commence infusion at 5-10mcg/kg/hr or 2/3 of previous hour dose requirement, titrate to response

Incompatibilities

• Avoid coadministration especially with preparations containing bisulfite or metabisulfite (all inotropes/vasopressors except ephedrine, milrinone, vasopressin), alkaline pH, or large anions

Practice tips

• The duration of action of naloxone may be shorter than the duration of the opioid being reversed (particularly long-acting agents – morphine, hydromorphone, higher dose fentanyl, SR oral opioids); ~2 hours observation for recrudescence of opioid effects is warranted, supplementary dosing or an infusion may be required
• Reversal of the effects of buprenorphine may be incomplete or require higher dosing due to its high receptor affinity
• Naloxone has been investigated for its use in septic shock and clonidine overdose, though its clinical role is not established