Names and pronunciation
(nal-oks′one) Evzio, Kloxxedo, Narcan, Zimhi
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Individual generic drug information
Extracted information for naloxone only.
(nal-oks′one) Evzio, Kloxxedo, Narcan, Zimhi
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Func. class.: Opioid antagonist, antidote
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Chem. class.: Thebaine derivative
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Do not confuse: naloxone/naltrexone/nalbuphine/ Naloxegol
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ACTION: Competes with opioids at opiate receptor sites
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USES: Respiratory depression induced by opioids, opiate agonist overdose Unlabeled uses: Pruritus (opiate induced)
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Extracted information for naloxone only.
CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, neonates, CV disease, opioid dependency, seizure disorder, drug dependency, hepatic disease
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SIDE EFFECTS CV: Rapid pulse, ventricular tachycardia, fibrillation, hypo/hypertension GI: Nausea, vomiting CNS: Headache, seizures MS: Pain INTEG: Injection site reactions MISC: Withdrawal symptoms in those dependent EENT: Nasal dryness
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INTERACTIONS Increase: seizure risk—traMADol overdose Decrease: effect of opioid analgesics
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Extracted information for naloxone only.
DOSAGE AND ROUTES • Duration of some opioids may exceed duration of naloxone, additional doses may be needed Opioid-induced respiratory/CNS depression (known or suspected opiate agonist overdose) • Adult: IV/SUBCUT/IM 0.4-2 mg, re- peat q2-3min if needed, max 10 mg; IV INFUSION loading dose 0.005 mg/ kg, then 0.0025 mg/kg/hr; IM/SUBCUT (Zimhi autoinjector only) 5 mg, may repeat q2-3min if needed • Child/adolescent 5-17 yr or ≥20 kg: IV 2 mg, may repeat • Child/infant <5 yr or ≤20 kg: IV 0.01 mg/kg slowly followed by 0.1 mg/kg if needed, may give IM/SUBCUT if IV not possible • Neonates: IM/IV/SUBCUT 0.01 mg/ kg, repeat q2-3min until adequate re- sponse • Adult/adolescent/child: NASAL 1 spray, may repeat q2-3min if needed Postoperative opioid-induced respiratory depression • Adult: IV 0.1-0.2 mg q2-3min prn • Infant/child/adolescent: IV 0.005- 0.01 mg/kg q2-3min prn
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Available forms: Inj 0.4 mg/mL, 1 mg/ mL; 1 mg/mL; auto injector 2 mg/0.4 mL, 5/0.5 mL; nasal spray 4 mg/0.1 mL; 8 mg (equal to 7.2 naloxone)/0.1mL unit dose device; solution for injection (Zimhi 5 mg/5 mL)
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Administer: • Only with resuscitative equipment, O2 nearby • Store in dark area at room temperature • Double-check dose; those taking opioids >1 wk are sensitive to this product • Solution should be clear Direct IV route • Undiluted (suspected opioid over- dose) or diluted with sterile water for inj; give ≤0.4 mg over 15 sec Continuous IV INFUSION route • Dilute 2 mg/500 mL 0.9% NaCl or D5W (4 mcg/mL); titrate to response • Do not admix with bisulfite, sulfites IM route with standard syringe • Inject deeply into a large muscle mass; aspirate • Use prepared solution within 24 hr IM route with autoinjector (Evzio) • Remove red safety guard; Evzio must be used immediately or disposed of properly. Give quickly into the anterolateral aspect of the thigh, through clothing if necessary. Press firmly and hold in place 5 sec • Upon activation, the needle is auto- matically inserted, delivers the injection, and then retracts fully • After initial injection, seek immediate medical attention. Keep patient under continued surveillance because the dura- tion of action of most opioids is longer than that of naloxone. Repeat doses q2- 3min as needed • Do NOT attempt to reuse Evzio; each device contains a single dose of naloxone Subcut • Inject undiluted solution, taking care not to inject intradermally Nasal route • Give as quickly as possible if a patient is unresponsive and an opioid overdose is suspected • Place the patient in the supine posi- tion. Assure that the device nozzle is in- serted into one of the patient’s nostrils and provide support to the back of the neck to allow the head to tilt back. Do NOT prime or test the device before ad- ministration • Press firmly on the device plunger • Turn the patient on his or her side (recovery position) and seek immediate medical assistance after the first dose of naloxone • Do NOT attempt to reuse the naloxone nasal spray device; each device contains a single dose • Using a new nasal spray device, read- minister naloxone q2-3min if the patient does not respond or responds and then relapses into respiratory depression • Administer the nasal spray in alternate nostrils with each dose Y-site compatibilities: Acyclovir, alfentanil, amikacin, aminocaproic acid, aminophyl- line, anidulafungin, ascorbic acid, ateno- lol, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleo- mycin, bumetanide, buprenorphine, butorphanol, calcium chloride/ gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexametha- sone, digoxin, diltiazem, diphenhy- drAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPI- NEPHrine, epirubicin, epoetin alfa, eptifi- batide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famoti- dine, fenoldopam, fentaNYL, flucon- azole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, indo- methacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, levo- floxacin, lidocaine, linezolid, LORazepam, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPRED- N NISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mito- XANtrone, morphine, moxalactam, multi- ple vitamins, mycophenolate, nafcillin, nalbuphine, nesiritide, netilmicin, nitro- glycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxali- platin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/ sodium, pentamidine, pentazocine, PENTo- barbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, pro- chlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiN- IDine, quinupristin-dalfopristin, ranitidine, ritodrine, rocuronium, sodium acetate/ bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thia- mine, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazo- line, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vin- CRIStine, vinorelbine, voriconazole, zole- dronic acid
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Extracted information for naloxone only.
Assess: • Withdrawal: cramping, hypertension, anxiety, vomiting; signs of withdrawal in drug-dependent individuals may occur ≤2 hr after administration; severity depends on length of time opioids were taken, naloxone dose • Respiratory dysfunction: respiratory depression, character, rate, rhythm; if res- pirations are <10/min, administer nalox- one; probably due to opioid overdose; monitor LOC, ECG, B/P • Vital signs q3-5min • Arterial blood gases, including PO2, PCO2 • Cardiac status: tachycardia, hyperten- sion, monitor ECG • Pain: duration, intensity, location be- fore and after administration; analgesia will be decreased; may be used for respi- ratory depression • Acute opioid reversal: patients may be- come very agitated and violent after use • Pregnancy/breastfeeding: use only if clearly needed, cautious use in breast- feeding
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Evaluate: • Therapeutic response: reversal of respiratory depression; LOC—alert
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • When patient is lucid, about the rea- sons for, expected results of product; for nasal administration, teach family, care- givers correct use, use of autoinjector
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Extracted information for naloxone only.
PHARMACOKINETICS Well absorbed IM, SUBCUT; metabolized by liver, crosses placenta; excreted in urine, breast milk; half-life 30-81 min IM/SUBCUT: Onset 2-5 min, peak 5-15 min, duration 45-60 min IV: Onset 1 min, peak 5 min, duration 45 min Nasal: Peak 20 min
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Filter the extracted dose blocks for this individual drug.
• Duration of some opioids may exceed duration of naloxone, additional doses may be needed Opioid-induced respiratory/CNS depression (known or suspected opiate agonist overdose)
Candidate age grouping · source page 930
• Adult: IV/SUBCUT/IM 0.4-2 mg, re- peat q2-3min if needed, max 10 mg; IV INFUSION loading dose 0.005 mg/ kg, then 0.0025 mg/kg/hr; IM/SUBCUT (Zimhi autoinjector only) 5 mg, may repeat q2-3min if needed
Candidate age grouping · source page 930
• Child/adolescent 5-17 yr or ≥20 kg: IV 2 mg, may repeat
Candidate age grouping · source page 930
• Child/infant <5 yr or ≤20 kg: IV 0.01 mg/kg slowly followed by 0.1 mg/kg if needed, may give IM/SUBCUT if IV not possible
Candidate age grouping · source page 930
• Neonates: IM/IV/SUBCUT 0.01 mg/ kg, repeat q2-3min until adequate re- sponse
Candidate age grouping · source page 930
• Adult/adolescent/child: NASAL 1 spray, may repeat q2-3min if needed Postoperative opioid-induced respiratory depression
Candidate age grouping · source page 930
• Adult: IV 0.1-0.2 mg q2-3min prn
Candidate age grouping · source page 930
• Infant/child/adolescent: IV 0.005- 0.01 mg/kg q2-3min prn
Candidate age grouping · source page 930