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    Naloxone Drip Dosing

    Doses naloxone for acute opioid overdose.
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    IMPORTANT

    This dosing tool is intended to assist with calculation, not to provide comprehensive or definitive drug information. Always double-check dosing of any drug and consult a pharmacist when necessary.

    INSTRUCTIONS

    Use in patients with respiratory or central nervous system depression from opioid analgesic overdose.

    When to Use
    Pearls/Pitfalls
    Why 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.
    • 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.

    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.

    mg

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    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.

    Formula

    Continuous IV infusion starting rate (mg/hr) = (⅔× bolus dose mg) per hour. Half of the bolus dose may be administered 15 minutes after starting drip.

    Bolus dose = total dose required in the first 1 hour.

    Titrate to respiratory rate, hypoxia and/or CNS depression.

    Decrease rate if withdrawal symptoms occur.

    Evidence Appraisal

    Naloxone dosing was studied by Goldfrank et al 1986 in a two-phase pharmacokinetic study.

    Phase I: Determining rate of elimination of naloxone.

    • 7 volunteers.
    • IV bolus dose of naloxone given.
    • Serial plasma naloxone levels measured. 

    Phase II: Determining volume of distribution and mean beta rate of elimination.

    • 10 volunteers.
    • 2 mg or 4 mg IV bolus naloxone given, followed by continuous infusion of either 1.5 mg/hr or 3 mg/hr.
    • Serial plasma naloxone levels measured.

    Based on these parameters, a computer simulation determined:

    • ⅔ of the initial bolus dose will maintain plasma naloxone levels equal to or greater than naloxone levels that would have existed 30 minutes after the bolus dose.
    • A second bolus dose equal to half the initial bolus should be administered at 15 minutes to achieve predicted steady-state concentrations effectively.
    Dr. Lewis Goldfrank

    About the Creator

    Lewis Goldfrank, MD, FACEP, FAAEM, FAACT, FACMT, FACP, is the Herbert W. Adams Professor of Emergency Medicine at New York University. He is also the medical director of the New York City Poison Control Center. Dr. Goldfrank is perhaps best known as author and editor of the primary toxicology reference Goldfrank's Toxicologic Emergencies.

    To view Dr. Lewis Goldfrank's publications, visit PubMed

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