IN THE TREATMENT OF KNOWN OR SUSPECTED OPIOID OVERDOSAGE, THE INITIAL DOSE OF NALOXONE HYDROCHLORIDE IS 0.4 TO 2 MG GIVEN INTRAVENOUSLY AND REPEATED IF NECESSARY AT INTERVALS OF 2 TO 3 MINUTES. IF NO RESPONSE HAS BEEN OBSERVED AFTER A TOTAL DOSE OF 10 MG THEN THE DIAGNOSIS OF OVERDOSAGE WITH DRUGS OTHER THAN OPIOIDS SHOULD BE CONSIDERED. IF THE PATIENT IS SUSPECTED OF BEING PHYSICALLY DEPENDENT ON OPIOIDS THE DOSE MAY BE REDUCED TO 100 TO 200 MICROGRAMS TO AVOID PRECIPITATING WITHDRAWAL SYMPTOMS. IN CHILDREN, THE USUAL INITIAL DOSE IS 10 MICROGRAMS/KG INTRAVENOUSLY FOLLOWED, IF NECESSARY, BY A LARGER DOSE OF 100 MICROGRAMS/KG (FOR AN ALTERNATIVE CHILDREN'S DOSE SUGGESTED IN THE USA TO TREAT OPIOID INTOXICATION, SEE UNDER ADMINISTRATION, ). IN BOTH ADULTS AND CHILDREN, IF THE INTRAVENOUS ROUTE IS NOT FEASIBLE THE INTRAMUSCULAR OR SUBCUTANEOUS ROUTE CAN BE USED.
NALOXONE HYDROCHLORIDE MAY ALSO BE USED POSTOPERATIVELY TO REVERSE CENTRAL DEPRESSION RESULTING FROM THE USE OF OPIOIDS DURING SURGERY. FOR ADULTS, A DOSE OF 100 TO 200 MICROGRAMS (1.5 TO 3 MICROGRAMS/KG) MAY BE GIVEN INTRAVENOUSLY AT INTERVALS OF AT LEAST 2 MINUTES, TITRATED FOR EACH PATIENT IN ORDER TO OBTAIN AN OPTIMUM RESPIRATORY RESPONSE WHILE MAINTAINING ADEQUATE ANALGESIA.
ALL PATIENTS RECEIVING NALOXONE SHOULD BE CLOSELY OBSERVED AS THE DURATION OF ACTION OF MANY OPIOIDS EXCEEDS THAT OF NALOXONE AND REPEATED DOSES BY INTRAVENOUS, INTRAMUSCULAR, OR SUBCUTANEOUS INJECTION MAY BE REQUIRED. ALTERNATIVELY, TO SUSTAIN OPIOID ANTAGONISM, AN INTRAVENOUS INFUSION MAY BE USED. THE MANUFACTURER RECOMMENDS NALOXONE HYDROCHLORIDE 4 MICROGRAMS/ML IN SODIUM CHLORIDE 0.9% OR GLUCOSE 5%, INFUSED AT A RATE TITRATED IN ACCORDANCE WITH THE PATIENT'S RESPONSE, BOTH TO THE INFUSION AND PREVIOUS BOLUS INJECTIONS; MORE CONCENTRATED SOLUTIONS HAVE ALSO BEEN USED, AND AN INFUSION RATE OF 400 TO 800 MICROGRAMS/HOUR HAS BEEN SUGGESTED.
OPIOID-INDUCED DEPRESSION IN NEONATES RESULTING FROM THE ADMINISTRATION OF OPIOID ANALGESICS TO THE MOTHER DURING LABOUR MAY BE REVERSED BY GIVING NALOXONE HYDROCHLORIDE 10 MICROGRAMS/KG TO THE INFANT BY INTRAVENOUS, INTRAMUSCULAR, OR SUBCUTANEOUS INJECTION, REPEATED AT INTERVALS OF 2 TO 3 MINUTES IF NECESSARY. ALTERNATIVELY, A SINGLE INTRAMUSCULAR DOSE OF ABOUT 60 MICROGRAMS/KG MAY BE GIVEN AT BIRTH FOR A MORE PROLONGED ACTION. NALOXONE SHOULD BE GIVEN WITH CAUTION TO THE INFANTS OF OPIOID DEPENDENT MOTHERS SINCE WITHDRAWAL SYMPTOMS CAN RESULT.