NALOXONE (Narcan)

Name:	NALOXONE (Narcan^R)
Classification:	*narcotic antagonist* used in the reversal of narcotic induced respiratory depression has no analgesic properties used for reversal of respiratory depression during epidural narcotic administration low dose naloxone can decrease pruritis associated with epidural narcotic administration
Dose:	Supplied as: 0.4 mg/ml (1 mL amp) or 1 mg/ml (2 mL vial) Bolus: 0.1 - 0.2mg IV direct produces partial reversal of post-operative narcotic depression doses given at 2-3 minute intervals until desired degree of reversal is achieved (ie. adequate ventilation and alertness without significant pain) Treatment of known opiate overdose or to aid in the diagnosis of suspected overdose: 0.4 - 2mg IV direct Maintenance Infusions: loading dose: 0.4mg 0.1 - 0.4mg/h rate of administration titrated to the patient effect useful in patients requiring high doses or prolonged therapy
Administration:	IV Infusion: 4 mg in 50mL (0.08 mg/mL) dextrose 5% and sodium chloride 0.9% or 20 mg in 250 mL (0.08 mg/mL) infusion concurrent with epidural narcotics: 0.8mg/L prepared infusion solutions do not need to be protected from light
Adverse Effects:	hypertension or hypotension ventricular ectopic rhythms pulmonary edema (most common in post-operative patients with pre-existing cardiac disease, hypertension and patients receiving B₂ agonist therapy) nausea, vomiting, sweating: secondary to abrupt cessation/reversal of narcotic tremors hyperventilation or respiratory depression *in respiratory depression that is reversed with naloxone, monitor closely for rebound respiratory depression*
Caution:	*in patients with myocardial ischemia as rapid withdrawal of narcotic may result in hypertension and myocardial ischemia*
Drug Interactions:	naloxone + captopril = decreased captopril effect
Monitoring Therapy:	duration of action of some narcotics may exceed that of naloxone; patient should be observed continuously for respiratory depression and doses repeated as required heart rate Blood pressure respiratory rate and rhythm analgesic response rebound depression
Adult Critical Care Protocol:	May be administed IV direct or by IV infusion by a nurse in Adult Critical Care Continuous infusions must be administered by infusion device with pump library enabled.