Name: NALOXONE (NarcanR)
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
  • 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

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 
  • 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.

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: November 15, 2019