Naloxone infusion guidance

1. Draw up 10mg naloxone (25 x 400microgram vials) and make up to a total volume of 50ml with dextrose – this makes a 200 microgram/ml solution.
2. Start with an hourly infusion rate equal to around 60% of the total of the doses required to adequately reverse respiratory depression and maintain respiration for 15 minutes. (e.g. if 800 micrograms were initially required, then start at 500 micrograms/hr – 2.5ml/hr)
3. Titrate to desired clinical effect.

Make up solution containing 0.5mg/kg of body weight of naloxone to a final volume of 50mls – this will give 0.01 mg/kg/hr if infused at 1ml/hr and will allow more accurate dose adjustment.

Toxbase states the following criteria should be fulfilled prior to discharging a patient who has required a naloxone infusion:

1. Features of opioid toxicity have fully resolved

2. The patient has maintained adequate ventilation without naloxone for at least 6 hours, or 12 hours if patient has ingested a patch or an MR preparation

3. Exclude ongoing respiratory depression even in patients with normal respiratory rate before discharge, if necessary with blood gas analysis.

Note: adults who have ingested methadone must be observed for 12 hours from ingestion (24 hours for children) as well as fulfilling the above criteria.