Naloxone Drip Dosing

Why Use

The half-life of naloxone is between 30 and 100 minutes. Because the duration of action of most available opioids exceeds that of naloxone, repeated administration or a continuous IV infusion may be required to prevent recurrence of respiratory depression.

When to Use

Respiratory or CNS depression from opioid analgesic overdose. Respiratory depression responsive to naloxone administration. Respiratory depression requiring more than one IV dose of naloxone.

Formula

Pearls / Pitfalls

Goal is to maintain the same level of reversal following initial naloxone bolus. Bolus dose necessary to reverse the respiratory depressant effects of the opioid overdose should be determined clinically. Bolus dose = total dose required in the first hour.

Management

Consider admission to an intensive care setting to prevent recurrent CNS and/or respiratory sequelae or withdrawal.

Critical Actions

Adjust drip based on clinical status. Monitor patient in a intensive care setting.

Advice

Consider gastric decontamination for orally ingested opioid. Look for and remove patches if applicable. The drip may require frequent adjustment based on clinical status.