FIRST AID COVER LIMITED SOP Drugs IV Naloxone Hydrochloride (N, P) Drugs IM Naloxone Hydrochloride (T) 2A Bridge Approach Tel +44 (0)0775 908 6816 London NW1 8BD Office +44 (0)20 7692 3018 United Kingdom Fax +44 (0)20 7692 3018 E-mail enquiries@firstaidcover.co.uk Www www.firstaidcover.co.uk
Contents 1.0 Presentation... 3 2.0 Actions... 3 3.0 Indications... 3 4.0 Contra Indications... 3 5.0 Dosage and Administration... 3 6.0 Side - Effects... 4 7.0 Additional Information... 4 First Aid Cover Limited Page 2 of 6
1.0 Presentation Ampoule containing naloxone hydrochloride 400mcg / 1ml 2.0 Actions Antagonism of the effects (including respiratory depression) of opiod drugs 3.0 Indications Respiratory depression Depression of the cardiovascular system and CNS depression associated with opiod overdose Accidental overdose of opiod drugs such as morphine Overdose of some common analgesics, e.g. co proxamol, containing substances such as dextropropoxyphene and codeine (in combination with paracetamol) producing respiratory depression reversed by naloxone Unconsciousness associated with respiratory depression of unknown cause, where opiod overdose is a possibility (see unconscious patient guidelines) 4.0 Contra Indications Neonatal patients of opiod addicted mothers as serious withdrawal effects may occur emphasis should be on BVM ventilation and oxygenation 5.0 Dosage and Administration Adults: Respiratory arrest / extreme respiratory depression. When the urgency of the situation outweighs the need for a controlled effect 400mcg IV bolus If there is no response, administer, further doses of 400 micrograms, every 2 3 minutes until an effect is noted Repeated doses may need to be given up to every 2 3 minutes en route to hospital, as the half - life of naloxone is short The maximum dose of naloxone is 10mg (equivalent to 25 repeat doses of 400 micrograms) Respiratory depression. If a more controlled effect is required, e.g. in known or potentially aggressive patients who are suffering respiratory depression rather than arrest, dilute up to 800mcg (2ml of naloxone) into 8ml of water for injection or sodium chloride 0.9% up to a total of 10ml. Administer by slow IV injection, titrated to desired response First Aid Cover Limited Page 3 of 6
Aim to relieve respiratory depression, but maintain patient in a groggy state Children: 10 micrograms/kg IV/IM If no response (or partial but inadequate response) a subsequent dose of the 100 micrograms/kg IV/IM may be required (NOTE: This is ten times the initial dose) Neonatal 100 micrograms (0.25ml) Single dose IM only 6.0 Side - Effects In patients who are physically dependant on narcotic drugs, violent withdrawal symptoms, including cardiac arrhythmias, may be precipitated by naloxone. Ideally, in these cases titrate the dose of naloxone as described above, to effectively reverse the cardiac and respiratory depression, but still leave the patient in a groggy state 7.0 Additional Information This medicine may be administered by IV or IV route by HCP s and by IM route when administered by EMT staff when used in association with this SOP. Naloxone may be administered intramuscularly, undiluted, (into the outer aspect of the thigh or upper arm) when IV access is impossible, but absorption may be slow. Wherever possible, the IV route should be used unless EMT staff member. Overdose with opiod drugs can be fatal as a result of respiratory and cardiovascular depression. The effects of naloxone are short lived and patients frequently relapse once the drug has worn odd. All cases of opiod overdose should be transported to hospital, even if the initial response to naloxone has been good. If the patient refuses, consider, if the patient consents, a loading dose of 800mcg IM to minimise the risk described above: Some prescription opiod drugs include: Buprenorphine Codeine Dextromoramide Dipipanone Dextropropoxyphene First Aid Cover Limited Page 4 of 6
Diamorphine Dihydrocodeine Meptazinol Methadone Nalbuphine Morphine Oxycodone Pentazocine Pethidine Phenazocine Temgesic Used in combination in Codis, Diarrest, Migraleve, Paracodol, Phensedyl, Solpadeine, Solpadol, Syndol, Terpoin, Tyiex, Veganin Palfium Dicanol Distalgesic / co proxamol Heroin Co codamol, co dydramol DF118 Meptid Physeptone, Methadose Oramorph, Sevredol, MST Continus, SRM Rhotard Oxycontin Fortral Pamergan Narphen First Aid Cover Limited Page 5 of 6
Author: Guy Crofts; BSc (Hons); RGN; SRPara; PGDip (Anaes) Clinical Lead Reviewed by: Simon Nash - Operations Manager Document Creation Date 10/01/2009 Document Review Date 10/01/2010 and then annually Document Relevance Paramedic, nurse, doctor Document Type SOP Published on FAC website portal, hard copy on emergency vehicles and FAC office First Aid Cover Limited Page 6 of 6