What is the recommended administration rate for Narcan (naloxone) in an emergency setting?

Naloxone Administration Rate in Emergency Settings

For intravenous administration of naloxone in emergency settings, the medication should be administered slowly in increments of 0.1 to 0.2 mg every 2-3 minutes and titrated to achieve adequate ventilation and alertness without significant pain or discomfort. 1

Route of Administration and Dosing

• Intravenous (IV) administration is recommended in emergency situations due to its most rapid onset of action 1
• For initial reversal of respiratory depression, naloxone should be injected in increments of 0.1 to 0.2 mg intravenously at two to three minute intervals to achieve the desired degree of reversal 1
• If IV access is unavailable, intramuscular (IM) administration is an effective alternative with a recommended dose of 2 mg repeated in 3-5 minutes if necessary 2
• Intranasal (IN) administration with a 2 mg dose is also a viable option, typically repeated in 3-5 minutes if necessary 2

Clinical Considerations

• Too rapid reversal of opioid effects may induce nausea, vomiting, sweating, or circulatory stress 1
• Larger than necessary dosage of naloxone may result in significant reversal of analgesia and increase in blood pressure 1
• The American Heart Association recommends using the lowest effective dose to minimize withdrawal symptoms 2
• For known or suspected opioid overdose, an initial dose of 0.4 mg to 2 mg of naloxone hydrochloride may be administered intravenously, and repeated at two to three minute intervals if needed 1

Management Priorities

• Airway management and breathing support should be prioritized before naloxone administration 2
• Standard resuscitative measures should take priority over naloxone administration for patients in cardiac arrest 3
• For patients with a definite pulse but no normal breathing or only gasping (respiratory arrest), it is reasonable to administer naloxone in addition to providing standard BLS/ACLS care 3

Post-Administration Considerations

• Since the duration of action of naloxone (typically 30-60 minutes) may be shorter than the respiratory depressant effects of many opioids, patients should be observed in a healthcare setting until the risk of recurrent opioid toxicity is low 3
• Repeated small doses or an infusion of naloxone may be beneficial if recurrent opioid toxicity develops 3
• If no response is observed after 10 mg of naloxone have been administered, the diagnosis of opioid-induced toxicity should be questioned 1

Common Pitfalls to Avoid

• Naloxone will not reverse respiratory depression due to non-opioid drugs such as benzodiazepines 2
• Administering naloxone too quickly or in excessive doses can precipitate acute withdrawal syndrome in opioid-dependent patients, including hypertension, tachycardia, vomiting, and agitation 2
• Delaying standard resuscitation measures while waiting for naloxone to take effect 3
• Failing to recognize that mixed overdoses (opioids plus other substances) may require additional interventions beyond naloxone 2