Naloxone hydrochloride may be administered by IV, IM or SC injection or IV infusion.
Adults:
Naloxone may be diluted for intravenous infusion in normal saline or 5% dextrose solutions. The addition of 2 mg of naloxone in 500 ml of either solution provides a concentration of 4 micrograms/ml. Infusion should be commenced as soon as practicable after preparation of the mixture in order to reduce microbiological hazards. Preparations not used within 24 hours should be discarded.
The rate of administration should be titrated in accordance with the patient’s response. Parenteral drug products should be inspected visually for particulate matter and discolouration prior to administration whenever solution and container permit.
Naloxone hydrochloride may be used postoperatively to reverse central depression resulting from the use of opioids during surgery. The usual dosage is 100 - 200 micrograms IV given at 2 to 3 minute intervals to obtain optimum respiratory response while maintaining adequate analgesia. Additional doses may be necessary at one to two hour intervals depending on the response of the patient and the dosage and duration of action of the opioid administered.
For the treatment of known opioid overdosage or as an aid in the diagnosis of suspected opioid overdosage, the usual initial adult dosage of naloxone hydrochloride is 400 - 2000 micrograms IV, administered at 2 to 3 minute intervals if necessary. If no response is observed after a total of 10 mg of the drug has been administered, the depressive condition may be caused by a drug or disease process not responsive to naloxone. When the IV route cannot be used, the drug may be administered by IM or SC injection.
For respiratory depression caused by mixed agonist/antagonists, such as buprenorphine , a continuous intravenous administration of naloxone at a rate of 4mg/70kg/hour is recommended to prevent the recurrence of respiratory depression.
Children:
The usual initial dose in children is 10 micrograms / kg bodyweight given IV. If the dose does not result in the desired degree of clinical improvement, a subsequent dose of 100 micrograms / kg body weight may be administered. If the IV route of administration is not available, naloxone may be administered IM or SC in divided doses. If necessary naloxone can be diluted with sterile water for injection.
Opioid - induced depression in neonates resulting from the administration of opioid analgesics to the mother during labour may be reversed by administering naloxone hydrochloride 10 micrograms / kg body weight to the infant by IM, IV or SC injections, repeated at intervals of 2 to 3 minutes if necessary. Alternatively, a single IM dose of about 60 micrograms / kg may be given at birth for a more prolonged action. It should be noted that onset of action is slower following IM injection.
Elderly:
In elderly patients with pre-existing cardiovascular disease or in those receiving potentially cardiotoxic drugs, naloxone should be used with caution since serious adverse cardiovascular effects such as ventricular tachycardia and fibrillation have occurred in postoperative patients following administration of naloxone.