Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

naloxone (Rx)Brand and Other Names:Narcan, Evzio

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 0.4mg/mL
  • 1mg/mL

IM/SC auto-injector

  • 0.4mg/0.4mL (2 auto-injectors/package)
more...

Opioid Reversal

0.4-4 mg IV/IM/SC; repeat q2-3min PRN; not to exceed 10 mg (0.01 mg/kg) 

Consider other causes of respiratory depression if desired response not achieved after 0.8 mg total

Endotracheal: 2-2.5 times (0.8-1 mg) initial IV dose

For chronic opioid abuse, use smallest doses (0.1-0.2 mg) and titrate to reversal of respiratory depression

Continuous IV infusion

  • For use in patients exposed to long acting opioids (eg, methadone), sustained release products
  • Calculate dose/hr based on effective intermittent dose used and duration of adequate response seen
  • Alternatively, use two-thirds of initial effective naloxone bolus on an hourly basis (0.25-6.25 mg/hr); administer one-half of initial bolus dose 15 min after initiating continuous IV infusion to prevent drop in naloxone levels

Opioid Overdose (Evzio Auto-Injector)

Indicated for the immediate administration as emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression

0.4 mg IM/SC into anterolateral aspect of the thigh (through clothing if necessary)

Seek emergency medical care immediately after use

Additional doses may be administered q2-3min until EMS arrives

Dosing considerations (Evzio)

  • Take-home, single-use auto-injector with visual and voice instruction for guidance
  • May be prescribed to a family member or caregiver
  • Compact size for portability with retractable needle system
  • Intended for immediate administration as emergency therapy in settings where opioids may be present
  • Not a substitute for emergency medical care

Dosage Forms & Strengths

injectable solution

  • 0.4mg/mL
  • 1mg/mL

IM/SC auto-injector

  • 0.4mg/0.4mL (2 auto-injectors/package)
more...

Opioid Reversal

Postanesthesia (acute) opioid reversal

  • Neonates: 0.01 mg/kg IV into umbilical vein/IM/SC; give subsequent dose of 0.1 mg/kg if needed 
  • Children: 0.01 mg/kg IV x1; may repeat with 0.1 mg/kg

Therapeutic opioid dosing

  • 0.00-0.015 mg/kg/dose IV/IM/SC/ET; may repeat PRN 

Acute opioid overdose

  • ≤20 kg or <5 years: 0.1 mg/kg/dose IV/IM/SC/ET; if needed, repeat q2-3min PRN; not to exceed 2 mg/dose 
  • >20 kg or ≥5 years: 2 mg IV/IM/SC/ET; if needed, repeat q2-3min PRN

Opioid Overdose (Evzio Auto-Injector)

Indicated for the immediate administration as emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression

0.4 mg IM/SC into anterolateral aspect of the thigh (through clothing if necessary); if child is <1 yr, pinch the thigh muscle while administering the dose

Seek emergency medical care immediately after use

Additional doses may be administered q2-3min until EMS arrives

Dosing considerations (Evzio)

  • Take-home, single-use auto-injector with visual and voice instruction for guidance
  • May be prescribed to a family member or caregiver
  • Compact size for portability with retractable needle system
  • Intended for immediate administration as emergency therapy in settings where opioids may be present
  • Not a substitute for emergency medical care
Next

Interactions

Interaction Checker

naloxone and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            Frequency Not Defined

            Withdrawal reaction precipitated

            Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness

            Cardiac arrest

            Ventricular fibrillation

            Dyspnea

            Pulmonary edema

            Abdominal cramps

            Diarrhea

            Previous
            Next

            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Caution in patients with cardiovascular disease or seizures

            Avoid excessive dose after use of opioids in surgery; abrupt postoperative reversal may cause nausea/vomiting, edema, tachycardia, sweating, and may unmask pain

            Recurrence of respiratory depression may occur if opioid involved is long-acting or a partial agonist (eg, methadone, buprenorphine)

            Opioid withdrawal

            • Use in patients who are opioid dependent may precipitate acute abstinence syndrome
            • Syndrome characterized by body aches, diarrhea, tachycardia, fever, runny nose, sneezing, piloerection, sweating, yawning, nausea or vomiting, nervousness, restlessness, or irritability, shivering or trembling, abdominal cramps, weakness, and hypertension
            • In neonates, opioid withdrawal may be life-threatening if not recognized and properly treated and may include convulsions, excessive crying, and hyperactive reflexes
            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not known if distributed in milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Competitive opioid antagonist; synthetic congener of oxymorphone

            Absorption

            Onset: 2 min (IV); 2-5 min (IM/SC)

            Duration: Depends on route of administration; generally 1-2 hr

            Elimination

            Half-life: 30-90 min (adults); 3-4 hr (neonates)

            Excretion: Urine

            Previous
            Next

            Administration

            IV Compatibilities

            Additive: Verapamil

            Syringe: Heparin, ondansetron, dimehydrinate

            Y-site: Fenoldopam, gatifloxacin, linezolid, propofol

            IV Incompatibilities

            Syringe: Pantoprazole

            Y-site: Amphotericin B cholSO4

            IV Preparation

            For infusion, dilute to 4 mcg/mL in D5W or NS

            Use within 24 hr

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.