Protocol for administration of naloxone (Narcan) at SSTAR for suspected opioid induced
respiratory depression.
Assessment:
1. Respirations less than 8/minutes AND
2. Patient not responding to tactile stimulation, AND
3. Previous documented or suspected use of opioids (e.g. heroin, morphine,
hypdromophone, methadone, fentanyl) prior to incident.
4. Do not use naloxone to reverse hypotension, nausea or vomiting from opioids or
seizures from meperidine (Demerol).
Procedure
Naloxone protocol may be initiated by staff members who have been trained in its use. A list of
trained staff members is maintained in Human Resources, as well as with individual supervisors.
Dose: Nasal naloxone 1 mg (1 ml) in each nostril for a total of 2 mg via atomizer. Response
should be seen within 2-5 minutes. Alternative is Naloxone 0.4 mg undiluted intramuscularly
every 2 minutes until spontaneous respirations. This injectable form must be given by a licensed
nurse or physician.
Call 9-1-1. Clients that have received naloxone are required to be evaluated in emergency
department.
Documentation:
1.Vital Signs
2. Level of consciousness
3. Dose, route and time of medication administration
4. Adverse reactions to naloxone
5. Respiratory depression secondary to opioid administration should be reported as an
event occurrence for risk management review.
Follow up:
All patients that have received naloxone and return to SSTAR must have respiratory assessment
(rate and rhythm) with documentation every hour for eight hours.
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Protocol Approved by Medical Director Date
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Staff Signature
Date/Time
REVIEWED 11/14
Medication Information
Classification: Naloxone (Brand name-Narcan) is a pure opioid antagonist that competes and
displaces narcotics at opioid receptor sites.
Use: Complete or partial reversal of opioid depression, including respiratory depression, induced
by natural and synthetic opioids, including heroin, oxycodone, hydrocodone, propoxphene,
methadone and certain mixed agonist- antagonist analgesics: nalbuphine, pentazocine and
butorphanol.
Duration of action: 20-60 minutes
Contraindications: Hypersensitivity to naloxone or any component of the formulation.
Warning/Precautions:
1. Due to an association between naloxone and acute pulmonary edema, use with caution
in patients with cardiovascular disease or in patients receiving medications with potential
adverse cardiovascular effects (e.g., hypotension, pulmonary edema or arrhythmias).
2. May precipitate withdrawal symptoms in patients addicted to opiates, including pain,
hypertension, sweating, agitation and irritability.
3. Recurrence of respiratory depression is possible if the opioid involved is long-acting;
patients require observation until there is no reasonable risk of recurrent respiratory
depression.
4. Use cautiously in patients with known renal insufficiency as it may have a prolonged
effect.
Pregnancy Risk Factor- C
Adverse reactions/withdrawal symptoms in opioid dependent patients should be documented and
may include:
Cardiovascular: Hyper/hypotension, tachycardia, ventricular arrhythmia, and cardiac arrest
Central Nervous System: Irritability, anxiety, narcotic withdrawal, restlessness, seizure
Gastrointestinal: Nausea, vomiting diarrhea
Neuromuscular/skeletal: Tremulousness
Respiratory: Dyspnea, pulmonary edema, runny nose, sneezing
Miscellaneous: Diaphoresis