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How do you administer naloxone?

Medically reviewed by Leigh Ann Anderson, PharmD Last updated on Jun 10, 2020.

Official Answer

by Drugs.com

Key Points

  • Naloxone products are now available that are more user-friendly for the lay public to administer to someone having opioid overdose.
  • These agents include naloxone nasal sprays (brand example: Narcan Nasal) and an auto-injector (brand example: Evzio). See below for instructions to administer naloxone (Narcan Nasal Spray or Evzio). 
  • During any opioid overdose emergency, call 911 or other emergency responders immediately after giving naloxone to the person who has overdosed. A repeat dose or a higher dose of naloxone may be needed. Naloxone is not a substitute for emergency medical care.

Naloxone has been available in injection form to reverse the effects of an opioid overdose for over 40 years. 

When first approved, naloxone treatments required administration via a syringe and needle and were most commonly used by trained medical personnel and emergency responders. Today, newer naloxone approvals come as nasal sprays and auto-injectors to make these life-saving drugs more user-friendly for the general public who may be first responders for an overdose.

Naloxone is available in different dose forms and can be given either as an injection or nasal spray. The injectable formulation can be given into a vein (intravenously), into the muscle (intramuscularly), or under the skin (subcutaneously). It is not addictive or considered an opioid itself. Review instructions when naloxone is first taken home, before an emergency situation should arise.

Most states have now passed legislation designed to improve lay-person access to naloxone at the pharmacy. More user-friendly naloxone products allow first-responders, the lay public, and family or friends to quickly administer naloxone in a life-threatening opioid (narcotic) overdose situation before emergency medical help arrives.

More user-friendly naloxone medications include:

  • Narcan Nasal (naloxone nasal spray)
  • Evzio (naloxone auto-injector)

How do I use Narcan Nasal Spray?

To use:

  1. Narcan Nasal Spray can be used for adults or children.
  2. Remove the Narcan Nasal Spray (naloxone nasal spray) from the box. DO NOT prime the device before administering.
  3. Place your thumb on the plunger bottom and your first and middle fingers on either side of the nozzle.
  4. The drug is sprayed into one nostril while the person is lying down on their back. Tilt the person’s head back and provide neck support with your hand.
  5. Gently insert the nozzle tip in one nostril until your fingers on either side of the nozzle touch the bottom of the person’s nose.
  6. Press the plunger firmly to give the full dose. Remove the spray bottle from the nose after the dose is given.
  7. Call 911 or get emergency medical help right away after giving the first dose of Narcan Nasal Spray.
  8. Move the person to their side (recovery position). If symptoms return or the person does not respond by waking up to voice or touch, give another dose in the other nostril after 2 to 3 minutes using a new Narcan Nasal Spray.
  9. Use alternate nostrils with each dose until emergency medical assistance arrives. Narcan Nasal Spray may be given every 2 to 3 minutes, if available.
  10. Fully review directions enclosed in the box when you receive the medication; do not wait until an overdose situation occurs.

Narcan Nasal Spray has been approved in 2 mg and 4 mg strengths. The lower 2-mg dose is for opioid-dependent patients expected to be at risk for severe opioid withdrawal in situations where there is a low risk for accidental or intentional opioid exposure by household contacts. It can easily be carried in a purse or pocket or stored in the home. No additional device assembly is required. 

You can store Narcan Nasal Spray store at room temperature 68°F to 77°F (20°C to 25°C). It does not need to be refrigerated. Do not freeze.

How do I use Evzio?

Read the "Instructions for Use" that comes with Evzio when you get it from the pharmacy or clinic. Evzio can be used in adults and children.

Evzio has built-in voice instructions to help guide administration, and directions are on the label, too.

When you need to use Evzio (naloxone auto-injector) for an overdose:

  1. Pull Evzio from the outer case.
  2. Pull off the RED safety guard when ready to use. Once the red safety guard is removed, Evzio must be used immediately or disposed of properly.
  3. Do not touch the Black base of the auto-injector, which is where the needle comes out. If an accidental injection happens, get medical help right away.
  4. Place the BLACK end of Evzio against the outer thigh. You may administer Evzio through clothing if necessary.
  5. Press firmly and hold in place for 5 seconds after you hear the click and hiss sound. If you are using Evzio in an infant less than one years old, pinch the middle of the outer thigh before and while giving Evzio.
  6. After using Evzio, get emergency medical help (call 911) right away. If symptoms return, another injection may be needed every 2 to 3 minutes. Closely watch the person until medical help arrives.
  7. The Evzio Auto-injector cannot be reused. To give another dose, a new Evzio case must be activated.

In 2014 the FDA approved Evzio (naloxone hydrochloride) intramuscular auto-injector as an emergency treatment for known or suspected opioid overdose.

Evzio is given via a hand-held auto-injector that delivers a single naloxone 0.4 mg dose. It can be carried in your pocket or stored in a medicine cabinet at home. It does not need to be refrigerated.

When Evzio is turned on, it provides verbal instructions to the user. This is an obvious advantage in a stressful, emergency situation that a lay-person might encounter.

An authorized generic version of Evzio is now available.

Because naloxone may not work as long as the opioid, a return of slowed or stopped breathing, unconsciousness, or other overdose symptoms may occur. A second repeat dose may be needed after 2 to 3 minutes until emergency help arrives.

If the voice instruction system does not operate properly, Evzio will still deliver the intended dose of naloxone hydrochloride when used according to the printed instructions on its label.

Store Evzio (naloxone auto-injector) at controlled room temperature 15°C to 25°C (59°F to 77°F). It does not need to be refrigerated.

Injectable naloxone hydrochloride

  • The naloxone hydrochloride injectable formulation is used in clinic and hospital settings as an intravenous or intramuscular injection.
  • Kit with 2 syringes and 2 vials of 0.4 mg/mL injectable naloxone may also be sold to emergency first-responders.
  • Naloxone vials may also sold in a kit with nasal atomizers for use as a nasal spray.
  • All kits contain an instruction chart for use and assembly direction.

Bottom Line

Naloxone is given to reverse slowed or stopped breathing, extreme sedation, and unconsciousness that occurs in someone who experiences an opioid (narcotic) overdose.

Naloxone is now available in products that are easier for the general public, friends and family to administer. These agents include a naloxone nasal spray (brand example: Narcan Nasal) and an auto-injector (brand example: Evzio).

Naloxone can also be given by intravenous, intramuscular or subcutaneous injection, and may be given this way in a clinical or hospital.

This is not all the information you need to know about naloxone for safe and effective use in an emergency overdose. Review the the use of naloxone, Evzio or Narcan Nasal Spray before an emergency overdose situation, and discuss this information with your doctor or other health care provider.

References
  • Narcan (naloxone) [Package Insert]. Revised March 2020. Adapt Pharma. Plymouth Meeting, PA Accessed June 10, 2020 at https://www.narcan.com/static/NARCAN-Prescribing-Information.pdf
  • Naloxone injection. [Package insert]. DailyMed. US National Library of Medicine. Accessed June 10, 2020 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=73c1bad3-6ac3-8682-e053-2a91aa0a176a
  • Naloxone hydrochloride. Injection. Drugs.com. Accessed June 10, 2020 at https://www.drugs.com/pro/naloxone.html
  • Authorized Generic for Evzio. Naloxone HCL auto-injector [Package Insert]. Accessed June 10, 2020 at https://naloxoneautoinjector.com/

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