1. Naloxone: Prescribing and Dispensing
Audrey Kivlehan
Student Pharmacist, Northeastern University

2. 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

3. 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

4. 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?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12.
References

13. 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