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Naloxone

    Brands

    DEA Class; Rx

    Common Brand Names; Zimhi

    • Opioid Antagonists; 
    • Opioid Reversal Agents

    naloxone intranasal (Rx)

    Brand and Other Names:Narcan Nasal Spray, Kloxxado
    • Classes: Opioid Reversal Agents

    Opioid antagonist; derivative of oxymorphone
    Used for reversal of opioid-induced respiratory and CNS depression
    Auto-injector and nasal formulations available to treat or prevent an overdose outside of health care setting

    Indicated for the complete or partial reversal of opioid depression (including respiratory depression) induced by natural and synthetic opioids

    Indicated for emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system (CNS) depression

    Intended for immediate use as emergency therapy in settings where opioids may be present

    For reversal of opiate agonist-induced respiratory depression.

    For the treatment of pruritus due to specific conditions.
    For the treatment of unexplained coma in an unresponsive patient.
    For opiate agonist dependence diagnosis.

    Hypersensitivity

    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

    Cardiac arrest

    Hypertension

    Hypotension

    Ventricular tachycardia

    Paresthesia

    Restlessness

    Shivering

    Tonic-clonic seizures

    Yawning

    Diaphoresis

    Piloerection

    Hot flash

    Myalgia

    Tremor

    Weakness

    Rhinorrhea

    Sneezing

    Caution in patients with cardiovascular disease or patients receiving medications with potential adverse cardiovascular effects

    Caution in patients with history of seizures; avoid use in treatment of meperidine-induced seizures

    Recurrence of respiratory depression may occur if opioid involved is long-acting or a partial agonist (eg, methadone, buprenorphine); observe patients until there is no further risk of recurrent respiratory or CNS depression

    Avoid excessive dosages after use of opioids in surgery; abrupt postoperative reversal may unmask pain and may cause nausea, vomiting, sweating, seizures, hypertension, and tachycardia; other cardiovascular events, including pulmonary edema and arrhythmias may occur

    Pregnancy category: C

    Lactation: Not known if distributed in milk; use caution

    Adults

    2 mg per dose IV/IO/IM/subcutaneous (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 10 mg per dose IM/subcutaneous (10 mg/0.4 mL auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.

    Geriatric

    2 mg per dose IV/IO/IM/subcutaneous (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 10 mg per dose IM/subcutaneous (10 mg/0.4 mL auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.

    Adolescents

    2 mg per dose IV/IO/IM/subcutaneous (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 10 mg per dose IM/subcutaneous (10 mg/0.4 mL auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.

    Children

    12 years: 2 mg per dose IV/IO/IM/subcutaneous (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 10 mg per dose IM/subcutaneous (10 mg/0.4 mL auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.
    5 to 11 years and weighing more than 20 kg: 2 mg per dose IV/IO/IM/subcutaneous (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.
    1 to 4 years or weighing 20 kg or less: 0.1 mg/kg/dose IV/IO (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.

    Infants

    0.1 mg/kg/dose IV/IO (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.

    Neonates

    0.1 mg/kg/dose IV/IM (standard syringe); 5 mg per dose IM/subcutaneous (Zimhi auto-injector); 1 spray (4 or 8 mg) per dose intranasally; doses may be repeated to maintain opiate reversal.

    Naloxone

    injectable solution

    • 0.4mg/mL
    • 1mg/mL

    injectable solution, high-dose

    • 5mg/0.5mL prefilled syringe (Zimhi)

    intranasal solution (Narcan)

    • 2mg/actuation (equivalent to 1.8 mg naloxone)
    • 4mg/actuation (equivalent to 3.6 mg naloxone)

    intranasal solution (Kloxxado)

    • 8mg/actuation (equivalent to 7.2 mg naloxone)