Intranasal Naloxone Administration Timing for Opioid Overdose
For suspected opioid overdose, administer a second dose of intranasal naloxone if there is no response after 2-3 minutes from the first dose. 1, 2
Naloxone Administration Protocol
Initial Administration
- Activate emergency response system immediately upon encountering a person with suspected opioid overdose who is unresponsive and not breathing or breathing abnormally 1
- Provide high-quality CPR (compressions plus ventilation) while preparing naloxone 1
- Administer the first dose of intranasal naloxone while continuing resuscitative efforts 1, 2
Repeat Dosing
- If no response is observed after 2-3 minutes, administer a second dose of intranasal naloxone 2
- Continue to provide respiratory support until spontaneous breathing returns 2
- Additional doses may be required within 1-2 hour intervals depending on the type of opioid involved (particularly for long-acting opioids) 3
Post-Administration Monitoring
- Even after successful reversal, monitor the patient for at least 4-6 hours after the last naloxone dose 2
- For long-acting opioid overdoses, extended observation (12-24 hours) is recommended 2
- Be aware that naloxone's duration of action is approximately 45-70 minutes, which may be shorter than the duration of action of many opioids 2
Important Considerations
Route of Administration
- Intranasal naloxone (2 mg/mL concentration) has similar efficacy to intramuscular naloxone for opioid overdose reversal 4
- While the time from administration to clinical response may be slightly longer for intranasal compared to IV naloxone (12.9 vs. 8.1 minutes), the overall time from patient contact to clinical response is similar (20.3 vs. 20.7 minutes) 5
Dosing Considerations
- For adults, initial doses typically range from 0.4 mg to 2 mg 3
- Lower initial doses (0.04-0.4 mg) should be considered in opioid-dependent patients to avoid precipitating severe withdrawal 2
- Higher initial doses may be necessary for potent synthetic opioids 2
Potential Complications
- Watch for signs of acute withdrawal syndrome in opioid-dependent patients, including hypertension, tachycardia, vomiting, and agitation 2
- Be prepared for the possibility that multiple doses may be required, especially with potent synthetic opioids 2, 5
Critical Safety Points
- Always refer patients who respond to naloxone to advanced healthcare services due to the risk of recurrent respiratory depression 2
- The short duration of naloxone compared to many opioids creates a risk of re-sedation and respiratory depression after initial improvement 2, 3
- Training in opioid overdose response, including naloxone administration, significantly improves outcomes 1