Naloxone (Narcan ®)
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Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate]
|[2 mg] [500 ml]
Fluid restricted - Higher concentrations possible:
The first version of this monograph was written several years ago (~ 1993). Occasionally changes or updates are added based on newly available data. Most recent update (Sept 2013):
 Source: Helms RA, Quan DJ (eds). Textbook of Therapeutics: Drug and Disease Management. 8th ed. Philadelphia: Lippincott Williams St Wilkins; 2006. p 82.
 Source: https://www.anesthesia-analgesia.org/content/100/4/953.full
 Much higher concentrations were used in syringes: Source: Stewart JT, Warren FW, King DT, et al: Stability of ondansetron hydrochloride and 12 medications in plastic syringes. Am J Health-Syst Pharm: 1998. 55: 2630-4.
 Product Information: NARCAN(R) injection, naloxone hcl injection. Endo Pharmaceuticals,Inc.
Stability / Miscellaneous
|Dosing: Treatment of narcotic-induced respiratory depression: 0.4 to 2 mg IV / SC/ IM repeat q2 to 3 minutes prn
(if no response after 10 mg --- questionable narcotic ingestion).
DOSAGE AND ADMINISTRATION
Since the duration of action of some opioids may exceed that of naloxone, the patient should be kept under continued surveillance and repeated doses of naloxone should be administered, as necessary.
Intravenous Infusion: Naloxone Hydrochloride Injection, USP may be diluted for intravenous infusion in 0.9% sodium chloride injection or 5% dextrose injection. The addition of 2 mg of naloxone hydrochloride in 500 mL of either solution provides a concentration of 0.004 mg/mL. Mixtures should be used within 24 hours. After 24 hours, the remaining unused solution must be discarded. The rate of administration should be titrated in accordance with the patient’s response.
Naloxone Hydrochloride Injection, USP should not be mixed with preparations containing bisulfite, metabisulfite, long-chain or high molecular weight anions, or any solution having an alkaline pH. No drug or chemical agent should be added to Naloxone Hydrochloride Injection, USP unless its effect on the chemical and physical stability of the solution has first been established.
Usage in Adults:
Postoperative Opioid Depression: For the partial reversal of opioid depression following the use of opioids during surgery, smaller doses of naloxone hydrochloride are usually sufficient. The dose of naloxone should be titrated according to the patient’s response. For the initial reversal of respiratory depression, naloxone hydrochloride should be injected in increments of 0.1 to 0.2 mg intravenously at two to three minute intervals to the desired degree of reversal, i.e., adequate ventilation and alertness without significant pain or discomfort. Larger than necessary dosage of naloxone may result in significant reversal of analgesia and increase in blood pressure. Similarly, too rapid reversal may induce nausea, vomiting, sweating or circulatory stress.
Repeat doses of naloxone may be required within one to two hour intervals depending upon the amount, type (i.e., short or long acting) and time interval since last administration of opioid. Supplemental intramuscular doses have been shown to produce a longer lasting effect.
Septic Shock: The optimal dosage of Naloxone or duration of therapy for the treatment of hypotension in septic shock patients has not been established
Source: [package insert]