Naloxone A brief overview

Brought to you by the NIH Center of Excellence in Pain Education at Southern Illinois University Edwardsville and Saint Louis University

Naloxone may be prescribed as vial kits, an auto-injector, or a commercially available prepackaged nasal spray.

You can access detailed information regarding each of the products via Prescribe to Prevent by clicking here

Intranasal naloxone spray comes as a 4mg dose. Patients should be instructed to use 1 spray as directed for opioid overdose. Each package comes with 2 single use sprays

Naloxone 0.4mg/mL 1mL vials with 23 gauge, 3mL, 1 inch intramuscular syringes with instructions to inject 1 mL intramuscularly as needed for opioid overdose. Provide 2 vials when prescribing

Naloxone auto-injector (Evzio) was recently re-formulated and comes with #2 auto-injector devices and #1 trainer. Each auto-injector delivers 2mg of naloxone intramuscularly. Audio instructions are provided upon removal of red safety guard.

Who is a candidate for naloxone?

Taking an opioid concurrently with other respiratory depressant medications, namely benzodiazepines or barbiturates

History of opioid use disorder or other substance use disorders

Co-occurring mental illness with current opioid use

Receiving opioid prescriptions from multiple doctors and pharmacies

Daily opioid doses that exceed 50mg of morphine equivalents

Prescribed rotating opioid medication regimens

Currently taking methadone or other ER / LA opioids

Recent opioid intoxication / overdose

Currently using heroin

Recent release from prison with a history of opioid abuse

Recent release from opioid treatment program

Co-ocurring renal dysfunction, hepatic disease, or respiratory diagnosis (smoking, COPD, asthma, sleep apnea) with co-occuring opioid use

Requirements for naloxone training session

Review the signs of opioid intoxication, overdose, and withdrawal
Ensure understanding of naloxone purpose
Review insurance coverage and personal preference for intramuscularly or intranasal delivery system
Discuss contents of naloxone kit, demonstrate administration (IM or IN) and verify understanding of method
Re-inforce importance of calling 911 and staying with person

Always call 911 and stay with patient after administration until first responders arrive

Document or record required patient information

The steps to helping a person with suspected overdose

1. Identify if someone is experiencing an overdose

No response after yelling their name or vigorously rubbing chest with knuckles, blue lips or fingertips, slow breathing (< 8 breaths / minute), limp body, or choking, gurgling, snoring noise.

Call 911 for help first!

Then provide mouth to mouth rescue breathing if breaths are shallow or non-existent

After contacting 911, administer naloxone and then place person in recovery position on their side with their top leg and arm crossed over their body
Stay with the person after administering naloxone. Do not leave them alone!
The effect of naloxone wears off after 30-90 minutes, shorter than some longer acting opioids such as controlled release products or methadone
Be cautious: Some patients may become agitated or combative or want to take more opioids upon reversal due to feeling opioid withdrawal symptoms
Get informed, get naloxone, safe a life

Developed by Kelly Gable, PharmD and Chris Herndon, PharmD

Information compiled from resources including individual naloxone administration device prescribing information, the Prescribe to Prevent website, the Substance Abuse and Mental Services Health Administration, the College of Psychiatric and Neurologic Pharmacists, NIH Pain Consortium, and the National Institutes of Drug Abuse

This project has been funded in whole or in part with Federal funds from the National Institutes of Health (NIH), Department of Health and Human Services, under Contract No. HHSN271201500056C. These materials are not in their final format. NIH is in the process of reviewing these materials.
Created By
NIH Center of Excellence in Pain Education at SIUE Herndon