random review (i.e. thing i looked up again recently): narcan (drip) dosing

19 Dec
Narcan = naloxone (opoid antagonist) 
Onset of action:
  • I.V.: ~2 minutes
  • Endotracheal, I.M., SubQ: 2-5 minutes
  • Inhalation via nebulization: ~5 minutes
  • Intranasal: ~8-13 minutes


  • ~30-120 minutes depending on route of administration
  • I.V. has a shorter duration of action than I.M. administration
  • shorter than that of most opioids, repeated doses are usually needed



I.V., I.M., SubQ:

  • 0.4-2 mg initial dose
  • can be IV push, but personally, I like drawing up your dose in a 10cc flush, and slow pushing (e.g. 1cc at a time), with the goal of titrating to breathing but NOT wide-awake-in-withdrawal-now-vomiting-and/or-punching-me
  • repeat PRN (probably in ~30-60 min)

Continuous infusion:

  • use two-thirds (2/3) of the initial effective naloxone bolus on an hourly basis (typically 0.25-6.25 mg/hour)
  • one-half (1/2) of the initial bolus dose should be readministered 15 minutes after initiation of infusion
  • adjust infusion rate as needed to assure adequate ventilation and prevent withdrawal symptoms


References: uptodate.com, picture



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