Toxicology 12: Narcotic Overdose Portal
Initial treatment of narcotic overdose with cardiopulmonary compromise includes the following:
Secure airway and provide high-flow oxygen.
Administer naloxone (Narcan, a narcotic antagonist) beginning with a dose of 2 mg IV. PEDS: In pediatric patients, the initial dose is 0.01 to 0.03 mg/kg. Naloxone may be administered IV, IM, SQ, ET, SL, and IN. IN administration is a needleless alternative to the injected route and can save lives while avoiding the need for intubation and reducing the risk to providers of needlestick injuries.1
Give nonresponsive adults up to 10 mg IV over a short period of time.
PEDS: Increase the next pediatric dose to approximately 0.1 mg/kg.
The effect half-life of naloxone is patient dependent and ranges from 15 to 45 minutes. Continuous naloxone infusion may be required for patients who have overdosed on long-acting narcotic preparations, such as methadone. Start a mixture of 8 mg of naloxone and 1000 mL of D5W at 100 cc/hour. This could be titrated to effect.
References
Koenig KL. Intranasal naloxone is effective for opioid overdose. Journal Watch Emergency Medicine. October 30, 2009.