Daily Bolus of LR: Use of naloxone

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May 23, 2011 by dailybolusoflr

Naloxone is an opioid antagonist.

 

·         It competes at all receptor subtypes but has the highest affinity for the µ receptor

·         Reversal will correct CNS, respiratory depression, analgesia, miosis, muscular rigidity (seen at times in fentanyl use) and delayed gastric motility

·         Onset of action with IV administration and is seen within 1-2 minutes

·         The half life is 60-90 minutes and typical duration of action is seen for about 20-90 minutes depending on route of use

·         For patients with apnea and who require immediate reversal, a dose of 0.4mg IV will likely reverse respiratory depression related to overdose

o   This dose will also likely induce withdrawal in opiate tolerant patients (agitation, nausea/vomiting/diarrhea/rhinorrhea etc)

o   With this in mind (imagine your co-ingestant patient with methadone and valium who is now deeply sedated from benzos but vomiting from withdrawal and now an aspiration/airway disaster)- consider titrating to effect which in most patients is NOT alertness but simply a RR over 8-12/minute.

o   A recommended starting dose is 0.04-0.1mg (this can be easily diluted with the available concentrations

§  0.4mg/cc- dilute this is 10cc NS and now you have 0.04mg/cc

§  1mg/cc- dilute this in 10cc and now you have 0.1mg/cc

 

·         If success is achieved and the patient has re-depression (seen in use of long acting opiates such as methadone), administer ½ the total bolus dose again and begin an infusion of naloxone at 2/3 the bolus dose/hour

·         If the patient develops withdrawal symptoms while on the drip, hold the drip until the symptoms abate and restart at half the prior dose

 

 

 

Goldfrank’sToxicology

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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