Parenteral Manual

Naloxone HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Narcotic analgesic
Original Date: 
August 2005
Revised Date: 
October 2020
  • Reversal of CNS and respiratory depression in narcotic overdose
  • Diagnosis of suspected acute narcotic overdosage
  • Opioid induced pruritis
Reconstitution and Stability: 
  • Available as 0.4 mg/mL injection
  • Store at room temperature
  • Protect from light
  • Stable in D5W and 0.9% NaCl at a concentration of 4 mcg/mL for 24 hours at room temperature

- Solutions Compatible: D5W, 0.9% NaCl

- Additive/Above Cassette Compatible: heparin (stable for 5 minutes)

- Y-site Compatible: KCl, propofol

- Incompatible: alkaline solutions; DO NOT mix with any parenteral preparation containing bisulfite, metabisulfite, sulfite or high molecular weight anions


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES; onset of action may be delayed
IM YES; onset of action may be delayed
IV Direct


Respiratory Arrest

  • Usual dilution: undiluted
  • Infusion time: Slowly, in 1/10 increments. Titrate to effect. Over 30 seconds.

Respiratory Depression

  • Usual dilution: 40 mcg/mL.    Mix 0.4 mg (400 mcg) 1 ml vial with 9 mL NaCL 0.9%  for 40 mcg/mL
  • Infusion time: slow IV push
IV Intermittent Infusion


IV Continuous Infusion

Usual dilution for opioid induced pruritis: 4 mcg/mL


Usual dilution for opiate overdose: 100 mcg/mL.   Add 2 mg (5mL) of naloxone 0.4 mg/mL to 15 mL  NaCL 0.9%  to make 20 ml final volume of naloxone 100 mcg/mL.




(For neonatal dosages, refer to Neonatal IV Drug Manual.)

- Opiate intoxication, respiratory arrest (full reversal):

  • Birth - 5 years or <20 kg:  0.1 mg/kg IV/IM/SC; Maximum dose = 2 mg; repeat every 2-3 minutes if needed then Q 30-60 minutes PRN
  • >5 years or >20 kg: 2 mg/dose IV/IM/SC; if no response, repeat every 2-3 minutes then Q 30-60 minutes PRN
  • IV infusion: 2.5-160 microgram/kg/hour (usual initial dose is 2/3 of the initial effective bolus dose given as an hourly infusion); titrate dose. Usually doses are between 24 - 40 mcg/kg/hr.

- Reversal of somnolence/respiratory depression from therapeutic opioid dosing

  • 2 mcg/kg/dose IV q2min PRN x 5 doses. Mix 0.4 mg (400 mcg) 1 ml vial with 9 mL 0.9% NaCL for 40 mcg/mL

- Post anesthesia narcotic reversal:     

  • 0.01 mg/kg; may repeat every 2-3 minutes as needed based on response

Opioid induced Pruritus

  • 0.25 to 2 mcg/kg/hour. 
  • Doses up to 3 mcg/kg/hour have been used.  However doses above 2 mcg/kg/hour increase the risk for loss of pain control and the patient may need increased opioid dose

- Narcotic overdose:   

  • 0.4-2 mg IV/IM/SC every 2-3 minutes as needed; may need to repeat doses every 20-60 minutes
  • NOTE: use 0.1-0.2 mg increments every 2-3 minutes in patients who are opioid dependent or in postoperative patients to avoid large cardiovascular changes
  • IV Infusion: 2.5-160 microgram/kg/hour (usual initial dose is 2/3 of the initial effective bolus dose given as an hourly infusion); titrate dose. Usually doses are between 24 - 40 mcg/kg/hr.



- Ontario Poison Center (OPC) has advised that higher doses of naloxone may be needed for potent fentanyl analogues.  Doses of up to 12 mg have been reported although the average dose has been up to 3 mg.

- OPC recommendations:

   - for non responsive patients with a pulse, but NOT BREATHING:  administer 0.4 mg IV/IM.  If no response in 3 minutes, administer 2 mg IV/IM.  If no response in a further 3 minutes, administer  4 mg IV/IM. Anticipate doubling the dose until a cumulative dose of 12 mg has been given.

   - for patient in cardiac arrest suspected to be result of an opiod overdose:  administer 2 mg IV/IM.  Anticipate increasing doses; can be doubled every 3 minutes if no response, to a maximum of 12 mg.

Potential hazards of parenteral administration: 
  • May precipitate acute withdrawal symptoms in patients with physical dependence to opiates(hypertension, sweating, agitation)
  • Hypertension, hypotension, tachycardia, arrhythmias
  • Nausea and vomiting with large doses (rare)
  • May cause severe hypertension if used in post-operative patients.  Should be given slowly and titrated to desired respiratory rate
  • Onset: within 2 minutes
  • Short duration of action (20-60 minutes); may require multiple doses
  • Monitor respiratory rate, heart rate, blood pressure, neurological status

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