💊 Opioid Overdose Reversal (Naloxone)
This tool gives the naloxone dosing strategy for opioid overdose by setting and dependence, emphasizing ventilatory support and observation for recurrence.
Opioid Overdose Reversal (Naloxone)
Setting
Opioid dependence/chronic use
When to use
Use to start airway/ventilation first, then dose naloxone appropriately, titrating low in dependent patients and observing for re-narcotization.
How it works
Airway/ventilation first. Out-of-hospital 0.4 mg IM or 4 mg intranasal. In-hospital non-dependent 0.4 mg IV titrated; dependent 0.04–0.1 mg IV to avoid withdrawal; up to 10 mg. Observe ≥ 2–4 h; infusion for long-acting/large overdoses.
Key points
- The goal of naloxone is adequate ventilation and airway protection, not full arousal, since over-reversal precipitates withdrawal and pulmonary edema. (original synthesis · not guideline verbatim)
- Naloxone is shorter-acting than most opioids, so respiratory depression can recur and observation is required.
- No response after a cumulative 10 mg prompts reassessment for a non-opioid cause.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.