Category: Opioid Toxicity

Naloxone "conservative dosing" when administering SC/IM/IN

Question #: 331


Under the opioid toxicity medical directive there is no minimum dose mentioned for Narcan, only a max single dose of 0.8mg. Is it acceptable to give less than 0.8mg SC/IM/IN without a patch to BHP and document "conservative dosing" on the ACR?


Naloxone, overall, is a safe medication when administered in doses and routes recommended in the ALS PCS.

The main reason you are administering Naloxone is that you are/will be in a position where it is impossible for you to adequately ventilate and oxygenate your patient. Knowing that, it is important to know that there’s a possibility a smaller Naloxone dose may not work for your patient. It will then take a longer time to achieve your patient care goal – oxygenation and ventilation.

Instead of “conservative dosing”, an option that can assist in establishing a treatment plan tailored to your patient needs, is to look at absorption rates of each route of administration. SC has a much lower rate of absorption than IM or IN. If you are concerned about the dose, SC may be the most appropriate route for your patient without having to use “conservative dosing”.

Keep in mind that ventilation and oxygenation should be your first priorities in your treatment plan and can assist in decreasing the number of Naloxone doses you will need to administer.

At this moment, we recommend following the Opioid Toxicity treatment plan as described in the Medical Directive, while selecting the most appropriate route of administration, based on your patient needs.

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