AdultPediatricDosage Forms & Strengths injectable solution 0.4mg/mL 1mg/mL injectable solution, high-dose 5mg/0.5mL prefilled syringe (Zimhi) Opioid Overdose Indicated for the complete or partial reversal of opioid depression (including respiratory depression) induced by natural and synthetic opioids 0.4-2 mg IV/IM/SC; repeat q2-3min PRN; not to exceed 10 mg (0.01 mg/kg) Consider other causes of respiratory depression if desired response not achieved after administering 10 mg cumulative total Endotracheal (this is the least desirable route of administration and supported only by anecdotal evidence): 2-2.5 times (0.8-5 mg) initial IV dose For chronic opioid abuse, use smallest doses (0.1-0.2 mg) to avoid acute withdrawal; titrate to reversal of respiratory depression Following reversal, additional dose(s) may need to be administered at later interval (ie, 20 to 60 min) depending on type and duration of opioid Continuous IV infusion (Off-label) For use in patients exposed to long acting opioids (eg, methadone), sustained release products Calculate dose/hr based on effective intermittent dose used and duration of adequate response seen Alternatively, use two-thirds of initial effective naloxone bolus on an hourly basis (0.25-6.25 mg/hr); administer one-half of initial bolus dose 15 min after initiating continuous IV infusion to prevent drop in naloxone levels Zimhi High-Dose Indicated for immediate administration as emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression 5 mg IM/SC into anterolateral aspect of the thigh (through clothing if necessary); if child is <1 yr, pinch the thigh muscle while administering the dose Seek emergency medical care immediately after use Additional doses may be administered q2-3min until EMS arrives Reversal of Respiratory Depression with Therapeutic Opioid Doses 0.04-0.4 mg IV/IM/SC initially; may repeat until desired response achieved; if desired response not observed after 0.8 mg total, consider other causes of respiratory depression Postoperative Opioid Depression 0.1-0.2 mg IV q2-3min to desired degree of reversal (eg, adequate ventilation and alertness without significant pain) May repeat within 1-2hr intervals depending on amount, type (eg, short or long acting) and timing of last dose administered; supplemental IM doses have produced longer lasting effectsDosage Forms & Strengths injectable solution 0.4mg/mL 1mg/mL injectable solution, high-dose 5mg/0.5mL prefilled syringe (Zimhi) Opioid Reversal Postanesthesia (acute) opioid reversal Neonates: 0.01 mg/kg IV into umbilical vein/IM/SC; give subsequent dose of 0.1 mg/kg if needed Children: 0.01 mg/kg IV once; may repeat with 0.1 mg/kg Reversal of respiratory depression with therapeutic opioid dosing Manufacturer dosing: 0.005-0.01 mg; repeat q2-3min PRN based on response AAP dosing: 0.001-0.015 mg/kg/dose IV; titrate to effect Acute opioid overdose ≤20 kg or <5 years: 0.1 mg/kg/dose IV/IM/SC/ET; if needed, repeat q2-3min PRN; not to exceed 2 mg/dose >20 kg or ≥5 years: 2 mg IV/IM/SC/ET; if needed, repeat q2-3min PRN Consider endotracheal administration when IV/intraosseous route not available; optimal endotracheal dose unknown; 2-3 times the IV dose recommended Zimhi High-Dose Indicated for immediate administration as emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression 5 mg IM/SC into anterolateral aspect of the thigh (through clothing if necessary); if child is <1 yr, pinch the thigh muscle while administering the dose Seek emergency medical care immediately after use Additional doses may be administered q2-3min until EMS arrives Interaction CheckerEnter a drug name and naloxoneNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (0)Serious - Use Alternative (2)naldemedinenaldemedine, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive opioid receptor anatagonism and increased risk of opioid withdrawal.naloxegolnaloxegol, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration; potential for additive effect of opioid receptor anatagonism and increased risk of opioid withdrawal.Monitor Closely (0)Minor (1)elvitegravirelvitegravir decreases levels of naloxone by unknown mechanism. Minor/Significance Unknown. No dose adjustment of buprenorphine/naloxone is required upon coadministration with VITEKTA. Patients should be closely monitored for sedation and cognitive effects.elvitegravirMinor (1)elvitegravir decreases levels of naloxone by unknown mechanism. Minor/Significance Unknown. No dose adjustment of buprenorphine/naloxone is required upon coadministration with VITEKTA. Patients should be closely monitored for sedation and cognitive effects.naldemedineSerious - Use Alternative (1)naldemedine, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive opioid receptor anatagonism and increased risk of opioid withdrawal.naloxegolSerious - Use Alternative (1)naloxegol, naloxone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration; potential for additive effect of opioid receptor anatagonism and increased risk of opioid withdrawal. Frequency Not Defined 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 Contraindications Hypersensitivity Cautions 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 Opioid withdrawal Use in patients who are opioid dependent may precipitate acute abstinence syndrome Syndrome characterized by body aches, diarrhea, tachycardia, fever, runny nose, sneezing, piloerection, sweating, yawning, nausea or vomiting, nervousness, restlessness, or irritability, shivering or trembling, abdominal cramps, weakness, and hypertension In neonates, opioid withdrawal may be life-threatening if not recognized and properly treated and may include convulsions, excessive crying, and hyperactive reflexes Pregnancy category: C Lactation: Not known if distributed in milk; use cautionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Competitive opioid antagonist; synthetic congener of oxymorphone Absorption Onset: 2 min (IV); 2-5 min (IM/SC) Duration: Depends on route of administration; generally 1-2 hr Peak plasma concentration: 17.2 ng/mL (5-mg dose); 3.58 ng/mL (2-mg dose) AUC 0-inf: 26.6 ng⋅h/mL (5-mg IM dose); 9.97 ng⋅h/mL (2-mg IM dose) 0-0.04 h: 0.02 ng⋅h/mL (5-mg IM dose); 0.01 ng⋅h/mL (2-mg IM dose) 0-0.08 h: 0.15 ng⋅h/mL (5-mg IM dose); 0.04 ng⋅h/mL (2-mg IM dose) Elimination Excretion: Urine Half-life 30-90 min (adults); 3-4 hr (neonates) 1.5 hr (5-mg IM dose); 1.86 hr (2-mg IM dose) IV Compatibilities Additive: Verapamil Syringe: Heparin, ondansetron, dimehydrinate Y-site: Fenoldopam, gatifloxacin, linezolid, propofol IV Incompatibilities Syringe: Pantoprazole Y-site: Amphotericin B cholSO4 IV Preparation For infusion, dilute to 4 mcg/mL in D5W or NS Use within 24 hr IM/SC Preparation Before using, check to make sure the solution is not discolored Replace if the solution is discolored or contains a precipitate IM/SC Administration For IM or SC use only Administer into anterolateral aspect of the thigh (through clothing if necessary) Child aged <1 yr: Pinch thigh muscle while administering the dose Seek emergency medical care immediately after use Since the duration of action of most opioids exceeds that of naloxone and the suspected opioid overdose may occur outside of supervised medical settings, seek immediate emergency medical assistance, keep the patient under continued surveillance until emergency personnel arrive, and administer repeated naloxone doses as necessary Storage Store at controlled room temperature 15-25°C (59-77°F) excursions permitted between 4-40°C (39-104°F) BRAND FORM. UNIT PRICE PILL IMAGE naloxone injection- 1 mg/mL solutionnaloxone injection- 1 mg/mL solutionnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL solutionnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone injection- 0.4 mg/mL vialnaloxone nasal- 4 mg/actuation liquidNarcan nasal- 4 mg/actuation liquidCopyright © 2010 First DataBank, Inc.Select a drug:naloxone injectionnaloxone nasalPrint Patient Educationnaloxone injection NALOXONE - INJECTION (nal-OX-one) USES: This medication is used for the emergency treatment of known or suspected opioid overdose. Serious opioid overdose symptoms may include unusual sleepiness, unusual difficulty waking up, or breathing problems (ranging from slow/shallow breathing to no breathing). Other symptoms of overdose may include very small "pinpoint" pupils, slow heartbeat, or low blood pressure. If someone has serious overdose symptoms but you are not sure if the symptoms are due to overdose, give this medication right away anyway, since lasting slow/shallow breathing may cause permanent damage to the brain or death.Naloxone belongs to a class of drugs known as opioid antagonists. It works by blocking the effects of the opioid in the brain. This medication may not work as well to block the effects of certain types of opioids (mixed agonist/antagonists such as buprenorphine, pentazocine). With these types of opioids, blocking may be incomplete or you may need a higher dose of naloxone.Treatment of opioid overdose should also include breathing treatment (such as oxygen given through tubes in the nose, mechanical ventilation, artificial respiration). HOW TO USE: This medication is given by injection into a muscle or under the skin. It may also be given by injection into a vein, usually by a health care professional.If you are using this medication at home, learn all preparation and usage instructions from your health care professional and the product package. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.The dosage is based on your medical condition and response to treatment.The effects of this medication are rapid but not long-lasting. After giving naloxone, get medical help right away, even if the person wakes up. If symptoms return after giving an injection, give another naloxone injection every 2 to 3 minutes. Continue to closely watch the person until emergency help is received. Tell the healthcare professional that you have given an injection of naloxone. SIDE EFFECTS: Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.In someone who has been using an opioid regularly, withdrawal symptoms can happen suddenly after receiving this medication. Withdrawal symptoms may include body aches, fever, sweating, watering eyes, runny nose, sneezing, goose bumps, yawning, weakness, shivering/trembling, nervousness, restlessness, diarrhea, nausea/vomiting, stomach cramps, increased blood pressure, fast heartbeat. In babies younger than 4 weeks who have been receiving an opioid regularly, sudden opioid withdrawal may be life-threatening if not treated the right way. Symptoms in babies may include seizures, crying more than usual, and muscle twitching/spasms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before using naloxone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as irregular heartbeat, previous heart attack).Before having surgery, tell your doctor