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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

NALOXONE
(Narcan(R))

Indication

  • naloxone is indicated for the reversal of severe respiratory depression that is caused by narcotics. It is effective against natural (eg. morphine) and synthetic (eg. meperidine, fentanyl) narcotics; it is NOT effective against barbiturates, tranquilizers, non-narcotic anaesthetics or sedatives.
  • naloxone has also been studied experimentally in the treatment of septic shock.

Pharmacology

  • naloxone is essentially a pure opiate antagonist with little or no agonist (morphine-like) activity.
  • metabolized primarily in the liver
  • rapidly inactivated following oral administration, therefore very large doses are required if naloxone is given orally.
  • onset of actionIV:1 to 2 minutes
     SC,IM:2 to 5 minutes
  • naloxone's duration of action is 45 minutes to 4 hours; this is usually shorter than that of the narcotic. Thus, the effects of the narcotic may return as the effects of naloxone wear off, and repeated doses of naloxone may be required.

Side Effects

  • abrupt reversal of narcotic depression may result in vomiting, sweating, tachycardia, hypertension, tremors, agitation and irritability.

Precautions

  • infants must be kept under continuous surveillance
  • monitor respiratory rate, blood pressure, signs of irritability/agitation
  • note that repeated doses of naloxone may be required (see Pharmacology)

Dose

(REVERSAL OF NARCOTIC DEPRESSION)
  • 0.1 mg/kg: IV push over 30 seconds; IM, SC or intratracheal
  • may be given every 2 to 3 minutes until the effects of the narcotic are reversed
  • may need to repeat every 1 to 2 hours

Special Indication

  • ultra low dose (0.1 mcg/kg/h) naloxone has been used with very high doses of opioid infusions to minimize the development of tolerance
  • this is currently experimental and has NOT been studied in neonates
  • ultra low dose naloxone infusion is weaned over 3 days (50 % of initial rate X 2 days, 25 % of initial rate X 1 day, stop on Day 4) once the opioid infusion starts to decrease

Supplied

  • 0.4 mg/mL, 1 mL ampoule

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
  3. Committee on Drugs: Emergency drug doses for infants and children and naloxone use in newborns - clarification, Pediatrics 1989; 83: 803.
  4. Committee on Drugs: Naloxone dosage and route of administration for infants and children - addendum to emergency drug doses for infants and children, Pediatrics 1990, 86: 484-5.
  5. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  6. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.



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