Naloxone: Prescribing and Dispensing Audrey Kivlehan Student Pharmacist, Northeastern University Kivlehan.a@husky.neu.edu

Contents Introduction: What is Naloxone? Benefits and Barriers of Naloxone Use Basic Pharmacology Routes of Administration Injection Nasal Patient Population and Education Adverse Reactions Contents

Objectives After this course you will: Be able to weigh the positives and negatives of prescribing naloxone to a patient Have a basic understanding of the drug including its basic pharmacology and medicinal chemistry Understand the routes of administration available for naloxone and decide on one that best fits your patients needs Be able to educate your patient and their family members on the use of the drug and warn them of any adverse reactions Objectives

Naloxone only works to combat opioid overdose! Naloxone hydrochloride (Narcan) is a prescription medication that is indicated to reverse opioid depression in an overdose or postoperatively Naloxone only works to combat opioid overdose! This medication has been a source of controversy, however with safe prescribing, dispensing and counseling naloxone can be a treatment that addresses the opioid overdose epidemic in the USA In the United States, 100 people die from overdoses a day In 2011, of the 22,810 deaths related to pharmaceutical overdoses, 74% were due to opioid analgesics What is Naloxone?

Benefits and Barriers Benefits of Naloxone Use: Potential Barriers: Family members can use this drug to administer life-saving treatment for patients before emergency assistance arrives Naloxone availability may reduce opioid overdose in conjunction with education and counseling Potential Barriers: Stigma Patients may feel judged by physician or fear that their opioid medications may be affected Physicians may be fearful of scaring patient away or encouraging risky behavior Costly price The new auto injector (Evzio) runs around $250 per shot Benefits and Barriers

Basic Pharmacology Basic Pharmacology: Structure: Naloxone is an opioid antagonist that competes competitively with the opioid at the mu receptor Naloxone has higher affinity for the receptor and will replace the opioid Structure: Naloxone is a synthetic congener of oxymorphone oxymorphone naloxone Basic Pharmacology

Routes of Administration and Dosage Forms Injectable Intravenous Intramuscular Subcutaneous (0.4mg/1ml) Available as: Multi-dose vials (0.4mg/mL or 1mg/mL) Preservative free ampules (0.02mg/mL, 0.4mg/mL,or 1mg/mL) Nasally Intranasal kit (2.0mg/2ml) 2 mL pre-filled needleless syringe Intranasal mucosal atomizing device Always prescribe and dispense two doses of the drug Naloxone will not work after two doses have been administered Routes of Administration and Dosage Forms

Injectables Prescribing: Instructions for Use: Storage Conditions: The auto-injector (Evzio) has voice guided tutorial Patients need the vial and corresponding intramuscular needle for use Instructions for Use: Inject 1mL of naloxone into muscle Administer a second dose after 2 to 3 minutes if necessary Storage Conditions: Protect vial from light Injectables

Intranasal Prescribing: Instructions for Use: Patients need the prefilled syringe and corresponding nasal atomizer for use Instructions for Use: Tilt head back and spray 1mL into each nostril Administer a second dose after 3 to 5 minutes if necessary Intranasal

Patient Population and Education Who should be prescribed naloxone? Patients at risk for opioid overdose Patients who have someone who may access the opioid medications inappropriately (ex: children) Patient Education: Instruct patient and those who may be administering the drug to practice assembling the materials and demonstrate rescue breathing Warn patient that the drug will not help after two doses Naloxone only lasts between 30 to 90 minutes and depression may reoccur afterwards Seek immediate medical attention Patients may experience withdrawal symptoms after use Patient Population and Education

Adverse Reactions Potential Adverse Reactions: Nausea Vomiting Sweating Tachycardia Increased blood pressure Tremulousness Seizures Ventricular tachycardia and fibrillation Pulmonary edema Cardiac arrest The drug is likely to produce withdrawal symptoms These reactions will not occur with everyone and will vary with individuals. Adverse Reactions

http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/administer-naloxone/ http://www.drugs.com/pro/naloxone.html http://www.medpagetoday.com/Psychiatry/Addictions/45164 http://www.evzio.com/hcp/ http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html http://stopoverdose.org/pharmacy.htm http://www.rxlist.com/narcan-drug.htm http://www.nlm.nih.gov/medlineplus/druginfo/meds/a612022.html References

This informational piece about Naloxone is designed in the form of a PowerPoint presentation to be presented to physicians and pharmacists within a health care clinic or a hospital. Specifically, those working in primary care, ambulatory care, outpatient services and pain management are the target audience. The audience needs a simple and professional presentation of the topic with information necessary to safely prescribe and dispense the product. The audience will encounter this presentation at work or a conference and it will be given by a pharmacist. Additionally, the pharmacists in attendance may receive law-mandated continuing education credits from attending the presentation. In designing this document, my primary goal was to create an informative presentation that is visually appealing, professional and straight to the point. Unit 2 Reflection