Intense involvement of the physician is obviously required. Only in critical situations such as full respiratory arrest, should naloxone be administered by rapid, direct IV push in an undiluted form. Naloxone is not a benign drug and can produce serious side effects such as tachycardia, cardiac irritability, hypertension, and seizures. It can also produce a severe withdrawal reaction that is not tolerated well by critically ill or debilitated patients. Sudden and severe reversal of analgesia by this method is unnecessary and adds greatly to the suffering experienced by the patient.
Myoclonus is a fairly common side effect seen most often with higher opioid doses.
The patient may experience mild to moderate muscle jerks, most commonly during sleep, but occasionally throughout the day. If the jerking is mild and not bothersome to the patient, then a simple explanation that this is a potential side effect should reassure the patient. If persistent, or changing to another drug is not desirable, low doses of a benzodiazepine muscle relaxant may help. 1 mg bid. These drugs may add to sedation, and if the myoclonus is mostly a problem during sleep, they can be given at bedtime only.