Naloxone Dosage Guide

## Naloxone IS the Overdose Treatment Naloxone is not a substance people overdose on -- it is the treatment for opioid overdose. Understanding when and how to use it is critical. ## When to Use Naloxone Administer naloxone if you suspect an opioid overdose. Signs include: - Unresponsiveness (cannot be woken by voice or sternal rub) - Slow, shallow, or stopped breathing - Blue or gray lips and fingertips - Pinpoint pupils - Gurgling or snoring sounds - Limp body **When in doubt, give naloxone.** It will not harm someone who is not overdosing on opioids. If the person is unconscious from a non-opioid cause, naloxone simply will not do anything. There is no downside to administering it when unsure. ## Multiple Doses and Fentanyl The rise of illicitly manufactured fentanyl and its analogues (carfentanil, fluorofentanyl, etc.) has changed the naloxone landscape significantly. Because fentanyl is extremely potent and often present in large doses in illicit supplies: - **A single dose of naloxone may not be sufficient.** Fentanyl's high receptor affinity and the large quantities present in street drugs can overwhelm a single 4mg intranasal dose. - **Be prepared to give 2-3 doses** spaced 2-3 minutes apart. - **Continue rescue breathing** between doses if you are trained in CPR. Breathe for the person until the naloxone takes effect. - **Fentanyl analogues like carfentanil** may require even higher total naloxone doses. Hospital settings may use continuous IV naloxone infusion for these cases. ## After Reversal Even after successful naloxone reversal, the person must be monitored because: - **Renarcotization**: Naloxone's duration (30-90 min) is shorter than most opioids. The person can slip back into overdose as naloxone wears off. - **With fentanyl patches or extended-release formulations**, opioid release continues for hours. Multiple waves of renarcotization are possible. - **The person's tolerance has been pharmacologically reset** by the naloxone. If they use opioids again immediately after, even their "usual" dose can be fatal. ## Emergency Services Always call 911, even if naloxone appears to have worked. The person needs professional medical assessment. Paramedics can provide additional naloxone, monitor for renarcotization, check for complications (aspiration, hypoxia-related brain injury), and transport to a hospital if needed.