What is the proper protocol for entering Narcan (naloxone) orders?

From the Guidelines

The proper protocol for entering Narcan (naloxone) orders involves specifying the dose, route, frequency, and indications for administration, with initial orders typically including naloxone 0.2-2 mg administered intravenously, intramuscularly, subcutaneously, or intranasally, with repeat dosing every 2-3 minutes as needed for respiratory depression, as recommended by the 2023 American Heart Association guidelines update 1.

Key Considerations for Narcan Orders

• Dose: The initial dose of naloxone should be 0.2-2 mg, with higher doses of 2-4 mg potentially being more appropriate for suspected opioid overdose, as indicated in the 2023 guidelines update 1.
• Route: Naloxone can be administered intravenously, intramuscularly, subcutaneously, or intranasally, with the choice of route depending on the clinical scenario and the availability of equipment, as noted in the 2015 American Heart Association guidelines update 1.
• Frequency: Repeat dosing should be done every 2-3 minutes as needed for respiratory depression, with the goal of restoring and maintaining a patent airway and ventilation, as recommended by the 2015 guidelines update 1.
• Indications: Orders should clearly state the clinical parameters triggering administration, such as respiratory rate less than 8 breaths per minute, oxygen saturation below 90%, or signs of opioid toxicity, as indicated in the example answer.

Post-Administration Monitoring

• Patients should be monitored for at least 2 hours after naloxone administration, as the duration of action of naloxone (30-90 minutes) may be shorter than many opioids, potentially requiring redosing, as noted in the example answer.
• Healthcare providers should be prepared to adjust treatment based on patient response and the specific opioid involved, as recommended by the 2023 guidelines update 1.

Continuous Infusions

• In severe cases, continuous infusions of naloxone may be necessary, with the concentration typically ranging from 4-8 mcg/mL and the rate ranging from 0.04-0.16 mg/kg/hr, as indicated in the example answer.
• The goal of continuous infusion is to maintain a stable level of naloxone in the patient's system, preventing recurrence of respiratory depression, as recommended by the 2015 guidelines update 1.

From the FDA Drug Label

Dosage and Administration Naloxone Hydrochloride Injection, may be administered intravenously, intramuscularly, or subcutaneously. The most rapid onset of action is achieved by intravenous administration and it is recommended in emergency situations. Usage in Adults: Opioid Overdose—Known or Suspected: An initial dose of 0. 4 mg to 2 mg of naloxone hydrochloride may be administered intravenously.

The proper protocol for entering Narcan (naloxone) orders is to administer 0.4 mg to 2 mg of naloxone hydrochloride intravenously in emergency situations, with the option to repeat doses at 2 to 3 minute intervals if necessary.

• Initial dose: 0.4 mg to 2 mg intravenously
• Repeat dose interval: 2 to 3 minutes
• Maximum dose: 10 mg, after which the diagnosis of opioid-induced toxicity should be questioned 2

From the Research

Entering Narcan Orders

To enter Narcan (naloxone) orders, it is essential to follow proper protocol, considering the patient's condition and medical history.

• The decision to administer naloxone should be based on suspicion of opioid overdose, as stated in the study 3.
• Naloxone dosing regimens may vary depending on the opioid involved and the patient's response to treatment, as discussed in the study 4.
• It is crucial to consider the pharmacokinetics and pharmacodynamics of the opioid that was overdosed, as well as the potential for long-acting opioids to be resistant to naloxone's effects, as mentioned in the study 5.
• Patients with a history of opioid overdose may require a highly variable dose of naloxone, and higher doses may be associated with lower age, as found in the study 6.

Protocol Considerations

When entering Narcan orders, consider the following:

• The patient's medical history, including any previous opioid overdoses or naloxone administration, as discussed in the study 6.
• The potential for naloxone to induce withdrawal symptoms, and the need for titration to avoid harsh symptoms, as mentioned in the study 7.
• The importance of patient-centered communication and effective linkage to prevention, treatment, and harm reduction services, as emphasized in the study 7.
• The potential for refusal of emergency medical transport following opioid overdose reversal, and the need for conditions that promote connections to care, as discussed in the study 7.