Naloxone Use

Why this matters

Naloxone is for opioid-induced respiratory depression. The goal is breathing. It is not full wakefulness.

A very large first dose can trigger severe withdrawal. If the patient is not breathing, open the airway and ventilate. Do not wait on the drug alone. The card has the amount.

Goals of Therapy

• Restore adequate breathing and airway protection.
• The goal is not a fully awake, agitated patient.
• Buy time for transport and further care. Some fentanyl analogs need repeat doses per protocol.

Clinical sequence

1. Scene safety and standard precautions, per service policy.
2. Open the airway. Suction. Ventilate if the patient needs it. Do not wait on the drug alone if the patient is not breathing.
3. Give naloxone the way your protocol writes it. Intranasal, intramuscular, intravenous, and intraosseous options vary. Your protocol sets the milligrams. This site does not.
4. Reassess breathing. Repeat the dose per protocol if the patient still will not ventilate. Watch chest rise. Oxygen saturation may lag. Use waveform capnography when you have it.
5. Prepare for withdrawal agitation. Use de-escalation and restraint protocols if you need them. After a partial reversal, the patient may not have capacity to refuse. Follow local refusal rules.

Key points

• Oxygen saturation may lag. Watch chest rise, and use waveform capnography when you have it.
• A mixed-drug overdose may not fully normalize with naloxone alone. Keep supporting ventilation.
• For suspected opioid respiratory arrest, an antagonist should be given. In cardiac arrest, CPR comes first. During cardiac arrest from a presumed opioid overdose, an antagonist may be reasonable if it does not interrupt high-quality CPR. Naloxone must not stop compressions.
• Document times, doses, routes, and the respiratory response.

Common errors

• An intranasal spray with no airway positioning, in a mouth full of vomit.
• Calling it a naloxone failure, and assuming it was not an opioid, when the problem is a long apnea or a non-opioid sedative.
• Leaving a high-risk patient with no observation plan after reversal.

Practice

Related: Overdose & Toxidromes.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

• AHA 2025 Part 10: Adult and Pediatric Special Circumstances of Resuscitation — Naloxone for suspected opioid respiratory arrest. During cardiac arrest, only if CPR is not interrupted.
• NASEMSO National Model EMS Clinical Guidelines (2022) — Model EMS language for opioid overdose.
• America’s Poison Centers — Poison-center context for opioid overdose.
• The goal is restoration of ventilation, not full sudden wakefulness. Open the airway and ventilate first if the patient is not breathing.
• Your opioid-overdose protocol, and medical direction on titration and refusal.