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1 Adverse Reactions/Side Effects

CV: VENTRICULAR ARRHYTHMIAS, hypertension, hypotension. GI: nausea, vomiting. PDF Page #1
naloxone (nal-ox-one) Interactions
Narcan Drug-Drug: Can precipitate withdrawal in patients physically dependent on
Classification opioid analgesics. Larger doses may be required to reverse the effects of bupren-
Therapeutic: antidotes (for opioids) orphine, butorphanol, nalbuphine, or pentazocine. Antagonizes postoperative
Pharmacologic: opioid antagonists opioid analgesics.
Pregnancy Category B Route/Dosage
Postoperative Opioid-Induced Respiratory Depression
Indications
Reversal of CNS depression and respiratory depression because of suspected opioid IV (Adults): 0.02 0.2 mg q 2 3 min until response obtained; repeat q 1 2 hr if
overdose. Unlabeled Use: Opioid-induced pruritus (low dose IV infusion). Man- needed.
agement of refractory circulatory shock. IV (Children): 0.01 mg/kg; may repeat q 2 3 min until response obtained. Addi-
tional doses may be given q 1 2 hr if needed.
Action IM, IV, Subcut (Neonates): 0.01 mg/kg; may repeat q 2 3 min until response ob-
Competitively blocks the effects of opioids, including CNS and respiratory depression, tained. Additional doses may be given q 1 2 hr if needed.
without producing any agonist (opioid-like) effects. Therapeutic Effects: Rever- Opioid-Induced Respiratory Depression During Chronic (1 wk)
sal of signs of opioid excess.
Opioid Use
Pharmacokinetics IV, IM, Subcut (Adults 40 kg): 20 40 mcg (0.02 0.04 mg) given as small, fre-
Absorption: Well absorbed after IM or subcut administration. quent (q min) boluses or as an infusion titrated to improve respiratory function with-
Distribution: Rapidly distributed to tissues. Crosses the placenta. out reversing analgesia.
Metabolism and Excretion: Metabolized by the liver. IV, IM, Subcut (Adults and Children 40 kg): 0.005 0.02 mg/dose given as
Half-life: 60 90 min (up to 3 hr in neonates). small, frequent (q min) boluses or as an infusion titrated to improve respiratory
function without reversing analgesia.
TIME/ACTION PROFILE (reversal of opioid effects)
ROUTE ONSET PEAK DURATION Overdose of Opioids
IV, IM, Subcut (Adults): Patients not suspected of being opioid dependent
IV 12 min unknown 45 min
IM, Subcut 25 min unknown
0.4 mg (10 mcg/kg); may repeat q 2 3 min (IV route is preferred). Some patients
45 min
may require up to 2 mg. Patients suspected to be opioid dependent Initial dose
should bepto 0.1 0.2 mg q 2 3 min. May also be given by IV infusion at rate ad-
Contraindications/Precautions justed to patients response.
Contraindicated in: Hypersensitivity. IV, IM, Subcut (Children 5 yr or 20 kg): 2 mg/dose, may repeat q 2 3 min.
Use Cautiously in: Cardiovascular disease; Patients physically dependent on IV, IM, Subcut (Infants up to 5 yr or 20 kg): 0.1 mg/kg, may repeat q 2 3 min.
opioids (may precipitate severe withdrawal); OB: May cause acute withdrawal syn-
drome in mother and fetus if mother is opioid dependent; Lactation: Safety not es- Opioid-Induced Pruritus
tablished; Pedi: May cause acute withdrawal syndrome in neonates of opioid-depen- IV (Children): 2 mcg/kg/hr continuous infusion, mayqby 0.5 mcg/kg/hr every few
dent mothers. hours if pruritus continues.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
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2 IV Administration
Direct IV: Diluent: Administer undiluted for suspected opioid overdose. For
NURSING IMPLICATIONS opioid-induced respiratory depression, dilute with sterile water for injection. PDF Page #2
Assessment For children or adults weighing 40 kg, dilute 0.1 mg of naloxone in 10 mL of
Monitor respiratory rate, rhythm, and depth; pulse, ECG, BP; and level of sterile water or 0.9% NaCl for injection. Concentration: 0.4 mg/mL, 1 mg/mL,
consciousness frequently for 3 4 hr after the expected peak of blood or 10 mcg/mL (depending on preparation used). Rate: Administer over 30 sec-
concentrations. After a moderate overdose of a short half-life opioid, physical onds for patients with a suspected opioid overdose. For patients who develop
stimulation may be enough to prevent significant hypoventilation. The effects of opioid-induced respiratory depression, administer dilute solution of 0.4 mg/10
some opioids may last longer than the effects of naloxone, and repeat doses may mL at a rate of 0.5 mL (0.02 mg) direct IV every 2 min. Titrate to avoid withdrawal
be necessary. and severe pain. Excessive dose in postoperative patients may cause excitement,
Patients who have been receiving opioids for 1 wk are extremely sensitive to the pain, hypotension, hypertention, pulmonary edema, ventricular tachycardia and
effects of naloxone. Dilute and administer carefully. fibrillation, and seizures. For children and adults weighing 40 kg, administer 10
Assess patient for level of pain after administration when used to treat postopera- mcg/mL solution at a rate of 0.5 mcg/kg every 1 2 min.
tive respiratory depression. Naloxone decreases respiratory depression but also Continuous Infusion: Diluent: Dilute 2 mg of naloxone in 500 mL of 0.9%
reverses analgesia. NaCl or D5W. Infusion is stable for 24 hr. Concentration: 4 mcg/mL. Rate:
Assess patient for signs and symptoms of opioid withdrawal (vomiting, restless- Titrate dose according to patient response.
ness, abdominal cramps, increased BP, and temperature). Symptoms may occur Y-Site Compatibility: acyclovir, alfentanil, amikacin, aminocaproic acid, ami-
within a few minutes to 2 hr. Severity depends on dose of naloxone, the opioid in- nophylline, anidulafungin, argatroban, ascorbic acid, atropine, azithioprine, az-
volved, and degree of physical dependence. treonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, bu-
Lack of significant improvement indicates that symptoms are caused by a disease torphanol, calcium chloride, calcium gluconate, carboplatin, carmustine,
process or other non-opioid CNS depressants not affected by naloxone. caspofungin, cefazolin, cefoperazone, cefotaxime, cefotatan, cefoxitin, ceftazi-
Toxicity and Overdose: Naloxone is a pure antagonist with no agonist proper- dime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, cisplatin, clin-
ties and minimal toxicity. damycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dacti-
nomycin, daptomycin, dexamethasone sodium phosphate, dexmedetomidine,
Potential Nursing Diagnoses digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxy-
Ineffective breathing pattern (Indications) cycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide,
Ineffective coping (Indications) ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine,
Acute pain fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, furosem-
Implementation ide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin,
Do not confuse naloxone with Lanoxin (digoxin). Do not confuse Narcan (nalox- hetastarch, hydrocortisone sodium succinate, idarubicin, ifosfamide, imipenem/
one) with Norcuron (vecuronium). cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketamine, ketorolac,
Larger doses of naloxone may be necessary when used to antagonize the effects of labetalol, levofloxacin, lidocaine, linezolid, lorazepam, mannitol, mechloreth-
buprenorphine, butorphanol, nalbuphine, and pentazocine. amine, meperidine, metaraminol, methotrexate, methoxamine, methyldopate,
Resuscitation equipment, oxygen, vasopressors, and mechanical ventilation methylprednisolone sodium succinate, metoclopramide, metoprolol, metronida-
should be available to supplement naloxone therapy as needed. zole, midazolam, milrinone, mitoxandrone, morphine, multivitamins, mycophen-
Doses should be titrated carefully in postoperative patients to avoid interference olate, nafcillin, nalbuphine, nesiritide, nitroglycerin, nitroprusside, norepineph-
with control of postoperative pain. rine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel,
2015 F.A. Davis Company CONTINUED
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3
PDF Page #3
CONTINUED
naloxone
palonosetron, pamidronate, pancuronium, papaverine, pemetrexed, penicillin G
potassium, pentamidine, pentazocine, pentobarbital, phenobarbital, phentol-
amine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate,
potassium chloride, procainamide, prochlorperazine, promethazine, propofol,
propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, rocu-
ronium, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, su-
fentanil, tacrolimus, teniposide, theophylline, thiamine, ticarcillin/clavulanate, ti-
gecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin,
vasopressin, vecuronium, verapamil, vincristine, vinorelbine, voriconazole, zo-
ledronic acid.
Y-Site Incompatibility: amphotericin B cholesteryl, amphotericin B lipid com-
plex, amphotericin B liposome, dantrolene, diazepam, diazoxide, pantoprazole,
phenytoin, thiotepa, trimethoprim/sulfamethoxazole.
Additive Incompatibility: Incompatible with preparations containing bisulfite,
sulfite, and solutions with an alkaline pH.
Patient/Family Teaching
As medication becomes effective, explain purpose and effects of naloxone to pa-
tient.
Evaluation/Desired Outcomes
Adequate ventilation.
Alertness without significant pain or withdrawal symptoms.
Why was this drug prescribed for your patient?

Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.