Respiratory depression, coma and seizures associated with opioid poisoning are rapidly reversed by naloxone. Since naloxone does not depress the central nervous system and does not antagonize other CNS depressants such as barbituates, benzodiazepines, or alcohol, it is a safe diagnostic agent to rule out opioid poisoning in comatose patients with unknown drug ingestions. Naloxone is nontoxic even in doses ten to twenty times larger than recommended doses. Although narcotic withdrawal symptoms are likely to occur in patients physically dependent to opioids, the symptoms last for fifteen to thirty minutes after a recommended dose and usually do not interfere with patient management. The usual naloxone dose is 0.4 mg to 2 mg in children and adults given as an intravenous bolus.
Clinical response occurs within two to three minutes.
Additional doses should be given at two to three minute intervals as needed to reverse coma and cardiopulmonary depression. Patients who have overdosed with buprenorphine, propoxyphene, pentazocine or large doses of opioids may require naloxone doses as large as 0.1 mg per Kg or greater. Naloxone's duration of action is much shorter than the opioids it antagonizes . Give two-thirds of the initial bolus dose per hour and adjust the infusion rate as needed to assure adequate ventilation. Antilirium An anticholinesterase drug used to reverse central and peripheral anticholinergic manifestations of tricyclic antidepressants and other anticholinergic poisons.