Naloxone: Administration, Presentations, Dosage, Precautions and Side Effects

It is a medication designed to reverse opioid overdose rapidly.

It is an opioid antagonist that can reverse and block the effects of other opioids. You can quickly restore normal breathing to a person whose breathing has slowed or stopped due to an overdose of heroin or prescription drugs for opioid pain.

How is it administered?

The FDA approves three formulations:

  • Injectable (professional training required).
  • Generic brands of injectable naloxone vials are offered by a variety of companies that are included in the FDA’s Orange Book under “naloxone” (look for “injectables”).

There has been widespread use of improvised emergency kits that combine an injectable formulation of naloxone with an atomizer that can administer the drug intranasally.

The use of this product requires the user to receive training on proper assembly and administration.

These improvised intranasal devices may not provide equivalent naloxone levels to FDA-approved products.

The manufacturer of an internal spray device issued a voluntary recall on 10/27/16, noting that some of the machines “may not supply a fully atomized drug pen, making the drug potentially less effective.”

 

Presentations of Naloxone

EVZIO®: It is a prefilled automatic injection device that makes it easy for families or emergency personnel to inject naloxone quickly outside the thigh.

Once activated, the device provides verbal instructions to the user describing how to administer the medication, similar to automatic defibrillators.

NARCAN®: A pre-filled needle-free nasal spray that does not require assembly is sprayed into a nostril while patients lie on their backs.

Both NARCAN® Nasal Spray and EVZIO® are packaged in a cardboard box containing two doses to allow repeated dosing if necessary. They are relatively easy to use and suitable for home use in emergencies.

Who can give the medicine to someone who has had an overdose?

The liquid for injection is commonly used by paramedics, emergency room doctors, and other specially trained first responders. To facilitate ease of use, NARCAN® allows naloxone to be sprayed on the nose.

While improvised sprays have been used to convert syringes for use as a nasal spray, they may not deliver the proper dose.

Friends, family, and other people in the community can administer the injection of naloxone in self-injection and nasal spray to someone who has taken an overdose.

Some countries require a doctor to prescribe naloxone; In other countries, pharmacies can distribute the medication in an outpatient setting without a prescription from a doctor.

For the laws related to naloxone in your country, check the website of the Prescription Drug Abuse Policy System.

What can be provided?

The dosage varies according to the formulation, and sometimes more than one dose is needed to help the person start breathing again. Anyone who uses naloxone should carefully read the leaflet that comes with the product.

You can find copies of the leaflet for EVZIO® and NARCAN® Nasal Spray on the FDA website.

Precautions with Naloxone

People receiving naloxone should be watched constantly until emergency care arrives and for at least 2 hours by the medical staff after the last dose of naloxone to ensure that the breathing does not diminish or disappear.

What are the side effects?

It is a highly safe medication that only has a noticeable effect on people with opioids in their systems.

Naloxone can (but not always) cause withdrawal symptoms that can be uncomfortable but are not life-threatening; On the other hand, an overdose of opioids is hazardous for life.

Withdrawal symptoms may include headaches, blood pressure changes, rapid heart rate, sweating, nausea, vomiting, and tremors.

How much does naloxone cost?

The cost varies depending on where and how you obtain it. Patients with insurance should check with their insurance company to see their co-payment for EVZIO® or NARCAN® Nasal Spray.

Uninsured patients can verify retail costs with their local pharmacies. Kaleo, the manufacturer of EVZIO®, has a cost assistance program for patients with financial difficulties and without insurance.

Where can I get naloxone?

It is a prescription medication. However, you can buy naloxone in many pharmacies, in some cases without a prescription.

Community-based law enforcement, EMS, and naloxone distribution programs can apply to be a qualified buyer of naloxone or work with their state or local health departments.