Indications And Dose
Overdosage with opioids ▶BY INTRAVENOUS INJECTION ▶Child 1 month–11 years: Initially 100 micrograms/kg (max. per dose 2 mg), if no response, repeat at intervals of 1 minute to a max. of 2 mg, then review diagnosis; further doses may be required if respiratory function deteriorates, doses can be given by subcutaneous or intramuscular routes but only if intravenous route is not feasible; intravenous administration has more rapid onset of action ▶Child 12–17 years: Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients), then review diagnosis; further doses may be required if respiratory function deteriorates, doses can be given by subcutaneous or intramuscular routes but only if intravenous route is not feasible; intravenous administration has more rapid onset of action ▶Adult: Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients), then review diagnosis; further doses may be required if respiratory function deteriorates, doses can be given by subcutaneous or intramuscular routes but only if intravenous route is not feasible; intravenous administration has more rapid onset of action ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Child: Using an infusion pump, adjust rate according to response (initially, rate may be set at 60% of the initial resuscitative intravenous injection dose per hour). The initial resuscitative intravenous injection dose is that which maintained satisfactory ventilation for at least 15 minutes ▶Adult: Using an infusion pump, adjust rate according to response (initially, rate may be set at 60% of the initial resuscitative intravenous injection dose per hour). The initial resuscitative intravenous injection dose is that which maintained satisfactory ventilation for at least 15 minutes ▶BY INTRANASAL ADMINISTRATION ▶Child 14–17 years: 1.8 mg, administered into one nostril, if no response, give a second dose after 2–3 minutes. If the patient responds to the first dose then relapses into respiratory depression, give the second dose immediately. Further doses should be administered into alternate nostrils ▶Adult: 1.8 mg, administered into one nostril, if no response, give a second dose after 2–3 minutes. If the patient responds to the first dose then relapses into respiratory depression, give the second dose immediately. Further doses should be administered into alternate nostrils Overdosage with opioids in a non-medical setting ▶BY INTRAMUSCULAR INJECTION ▶Adult: 400 micrograms every 2–3 minutes, each dose given in subsequent resuscitation cycles if patient not breathing normally, continue until consciousness regained, breathing normally, medical assistance available, or contents of syringe used up; to be injected into deltoid region or anterolateral thigh ▶BY INTRANASAL ADMINISTRATION ▶Child 14–17 years: 1.8 mg, administered into one nostril, if no response, give a second dose after 2–3 minutes. If the patient responds to the first dose then relapses into respiratory depression, give the second dose immediately. Further doses should be administered into alternate nostrils ▶Adult: 1.8 mg, administered into one nostril, if no response, give a second dose after 2–3 minutes. If the patient responds to the first dose then relapses into respiratory depression, give the second dose immediately. Further doses should be administered into alternate nostrils Reversal of postoperative respiratory depression ▶INITIALLY BY INTRAVENOUS INJECTION ▶Child 1 month–11 years: 1 microgram/kg, repeated every 2–3 minutes if required ▶Child 12–17 years: Initially 100–200 micrograms, alternatively (by intravenous injection) initially 1.5–3 micrograms/kg, if response inadequate, give subsequent doses, (by intravenous injection) 100 micrograms every 2 minutes, alternatively (by intramuscular injection) 100 micrograms every 1–2 hours ▶Adult: Initially 100–200 micrograms, alternatively (by intravenous injection) initially 1.5–3 micrograms/kg, if response inadequate, give subsequent doses, (by intravenous injection) 100 micrograms every 2 minutes, alternatively (by intramuscular injection) 100 micrograms every 1–2 hours DOSE EQUIVALENCE AND CONVERSION ▶With intranasal use ▶1 spray equivalent to 1.8 mg.
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