What Is Naloxone?

Due to the “opioid epidemic” in the United States, naloxone is increasingly mentioned on evening news broadcasts and in mainstream media. The question “What is naloxone?” is now being asked more and more often.

Essentially, naloxone is a potentially life-saving medication that can reverse an opioid overdose. In the United States, it is available in most states without a prescription, and it can be given as an injection or as a nasal spray.

How Does This Medication Work?

After administration, naloxone binds to receptors in the brain that also receive opioids such as morphine, hydrocodone, opium, heroin, and methadone. After binding to these receptors, naloxone blocks the effects of any opioids that may be in the body for between 30 to 90 minutes. This is normally sufficient time to reverse respiratory depression (very slow breathing), a frequent and potentially fatal complication that may occur with an overdose. This medicine normally starts working within two to three minutes after it is administered.

Importantly, this drug will only reverse the effects of opioids. It has no effect on other medicines that may be in the body. For example, it can’t reverse the effects of an overdose of alcohol, sedatives, stimulants, or benzodiazepines. However, since the majority of overdose cases involve a mixture of opioids and other drugs, using naloxone can help a patient who has overdosed begin breathing again. If a patient has no opioids in his or her body at the time of administration, naloxone will have no impact and cause no side effects.

What Conditions Does This Medicine Treat?

In addition to its primary use as emergency medication for overdoses, this medicine is also administered to confirm a diagnosis of an acute overdose of opioids. For patients who are in septic shock, this medicine can help stabilize and maintain blood pressure. Patients who are dealing with a substance use issue that involves buprenorphine, an opioid, may be offered a drug that contains both buprenorphine and naloxone as part of their treatment. The combination of these two medications works to decrease the patient’s dependency on buprenorphine.

How Effective Is This Medicine?

A recent study in Massachusetts showed that this medicine is more than 93 percent effective in reviving patients who have overdosed. The research was based on more than 12,000 doses administered over a two-and-a-half-year period.

Who Should Not Use Naloxone?

Studies have not been done on the safety of naloxone for women who are pregnant or breastfeeding. Patients who have cardiovascular disease should mention this to their doctor, if possible, before receiving this medicine.

In an emergency situation, however, it may not be possible to tell doctors about pre-existing health conditions, and the benefits of this potentially life-saving treatment far outweigh any risks. This medicine has safely been used in emergency settings for patients with cardiovascular concerns and for patients who are pregnant or breastfeeding. Naloxone can be used for neonates, children, and adults.

What Are the Potential Side Effects of This Medication?

Since this medicine is designed to quickly reverse the effects of opioids during a medical emergency, it typically triggers immediate symptoms associated with opioid withdrawal. Within two to three minutes of receiving naloxone, patients may start experiencing nausea, vomiting, or diarrhea. They may also have a fever and begin shaking or sweating. Some patients may exhibit sudden tremors or shiver, and the patient’s heart rate and blood pressure will likely increase. The patient may feel as though his or her heart is pounding, and he or she may also show signs of nervousness, agitation, or restlessness.

In addition, patients may develop widespread body aches, and they may also begin yawning. Some patients feel very weak after receiving this medication, and others may have a runny nose. If this medicine is administered to an infant under 4 weeks of age, the baby may exhibit stiffness and overactive reflexes. He or she may cry more than usual, and seizures have also been reported.

This medication does not produce a high, and it is not habit-forming. Patients will not build up a tolerance to this medication, and it can be administered safely and successfully to patients who have had it previously for a past overdose.

What Delivery Routes Are Used for This Medication?

This medicine can be given as a subcutaneous injection under the skin. Most commonly, it is given as an intramuscular injection in the outer thigh, and it may also be given intravenously (through a vein).

An auto-injector is available in the United States and other countries. This device is a pre-filled syringe with a needle size that is suitable for intramuscular injections. Several nasal spray options are available as well.

Who Can Administer This Medication?

This medicine can be administered by doctors, nurses, and emergency medical personnel. To help combat the opioid epidemic, many police departments routinely carry it, and they are also authorized to administer it. Since it is normally available without a prescription, caregivers, friends, and family of those struggling with a substance use issue are encouraged to keep it with them, and medical staff can instruct them in how to administer it safely.

What Should I Do Before Administering This Medicine?

Before using this medicine on a patient, friend, or loved one, check for signs of an overdose. Normally, patients who have overdosed will be unconscious, so try calling the person’s name and rubbing his or her chest with your knuckles to see if the patient will respond. If he or she doesn’t respond, listen to his or her breathing. If it is very slow or shallow, the patient could have overdosed. The patient may also show signs of gasping for air, and a snoring sound may also be present.

Next, continue checking the patient for signs of overdose by listening to his or her heartbeat or checking his or her pulse. You can feel the patient’s pulse by placing two fingers on the inside of his or her wrist or on the side of his or her neck. If a stethoscope is not available, place your ear on the patient’s chest to evaluate his or her heart rate. Patients who have overdosed will have a very slow heartbeat, often less than 50 or 60 beats per minute. Although this can only be checked with proper equipment, the patient’s blood pressure will also be very low.

Continue by checking the patient’s eyes and skin. Most overdoses constrict the pupils, and the patient’s skin may turn blue or be very pale. If any or all of these overdose signs are present, call for emergency medical care, and tell the dispatcher that the patient is unresponsive and is not breathing.

Finally, help the patient by giving rescue breaths. To do this, check that there is nothing inside the person’s mouth that may be blocking his or her breathing. If there is, remove it. Next, tilt the patient’s head back, and pinch both of his or her nostrils closed. Slowly breathe into the person’s mouth two times, and look to see if the chest rises. Give one of these rescue breaths every five seconds.

If the patient does not respond or start breathing on his or her own after 30 seconds of rescue breaths, administer naloxone. Then, continue giving rescue breaths once every five seconds. If the patient remains unresponsive three minutes after naloxone has been given, a second dose of the medication should be administered. Rescue breaths should be continued until emergency medical personnel arrive.

How Is This Medicine Administered?

Proper administration of this medicine varies depending on the route and device used. If using the nasal spray version of this medication, remove any cap that may be covering the nozzle. Hold the bottle by placing your thumb on the bottom of the plunger, and place two fingers on either side of the nozzle itself. Next, insert the nozzle into the patient’s nostril, advancing until the fingers you’ve placed on either side of the nozzle are touching the bottom part of the patient’s nose. Next, press up on the plunger with your thumb until it stops; this will administer the entire dose to the patient.

There are several different versions of the nasal spray available for this medication. Some of these look more like a syringe than a bottle, and they may require that you administer half of the spray in each of the patient’s nostrils. The directions on the package will tell you whether to administer into both nostrils and what the dose should be.

If using the auto-injector device to administer this medicine, remove the device from its outer case. When ready to use, remove the red safety guard. This will expose a black base that contains the needle; be careful not to touch the base. Next, place the black part of the device on the patient’s outer thigh. If necessary, you can place it over any clothing that the patient might be wearing; the device will still work.

Press the auto-injection device into the patient’s outer thigh for at least five seconds. This will release the needle and administer the dose. If done correctly, you’ll hear a click when the needle releases, and this will be followed by a hissing noise as the dose is administered. After the dose has been administered, you won’t be able to see the needle. Be careful to dispose of this device properly.

This medicine can be administered using an injection that is prepared at the time it is needed. This method is the hardest to administer, and it is most often used in health care settings.

To administer this type of injection, use a needle that is long enough to reach the patient’s muscle. Draw up 1cc of the drug into the syringe, and inject it into a large muscle. While the outer thigh is the most common place for administration, you can also give the injection into the patient’s shoulder or into the outer quadrant of the glute muscle.

What Should I Do After Administering Naloxone?

After naloxone has been administered, stay with the patient to monitor him or her until paramedics arrive. If the patient has regained consciousness, protect him or her from taking additional opioids; this could trigger another overdose that may require more doses of naloxone. Monitor the patient for signs of opioid withdrawal that may occur after giving this medication, and report these to paramedics. In particular, monitor the patient to make sure that he or she does not begin having chest pain or an irregular heartbeat.

After receiving this medication, some patients may experience seizures or hallucinations. It is also possible that the patient may go into cardiac arrest or lose consciousness again. Stay with the patient to keep him or her as safe as possible, and report any of these signs to the paramedics.

How Is This Medication Stored?

To make sure that this medicine will be effective when it is needed, proper storage is essential. Ideally, it should be stored in a dry, dark place that is between 40 and 80 degrees Fahrenheit. Exposure to sunlight may cause this medicine to lose its potency, so storing it in a cabinet is normally recommended. While this medicine may still be effective if it is expired or has been stored improperly, additional doses beyond the recommended dosage may be necessary to revive the patient.

How Can I Get This Medication for a Friend?

In 48 U.S. states, this medication can be obtained simply by asking the pharmacist to dispense it. Most pharmacies will have it available that same day. If it is not in stock, the pharmacist can order it for the next business day. The injectable form of this medicine is the cheapest, and the pharmacist can provide complete information about prices.

In states where a prescription is required for this medicine, patients or caregivers will need to ask a primary care physician to issue the prescription. In response to the opioid epidemic, many health officials are now urging everyone to carry a dose of this medicine with them. That way, bystanders will be able to help if they encounter an overdose in their community.

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