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Opioid Overdose and Reversal with Naloxone

Respiratory depression, pinpoint pupils and loss of consciousness are the classic opioid triad; naloxone rapidly restores breathing.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Opioid Overdose and Reversal with Naloxone?

Opioid overdose is a medical emergency characterized by the triad of respiratory depression, loss of consciousness and small (pinpoint) pupils. Heroin, oxycodone, fentanyl and methadone are the main responsible agents. Fentanyl-related deaths are increasing worldwide.

Naloxone is a competitive antagonist of the mu opioid receptor. It can be given IV, IM, SC, IO or intranasally. Onset of effect is 2–5 minutes, lasting 30–90 minutes. Repeated doses may be necessary with potent synthetic opioids such as fentanyl.

Treatment includes airway management, ventilatory support, naloxone administration and an observation period. The patient should be monitored for at least 4–6 hours due to the risk of re-narcotization.

Symptoms

Respiratory depression (<12/min)
Pinpoint pupils
Decreased consciousness, coma
Cyanosis
Hypotension and bradycardia
Nausea and vomiting
Decreased bowel sounds
Needle tracks (IV user)

Risk Factors

Pre-existing opioid dependence
Methadone maintenance therapy
Fentanyl-containing mixed products
Recent discharge from rehabilitation
Combination with benzodiazepines
Concomitant alcohol use
Long-acting formulations
Pediatric accidental exposure

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden loss of consciousness and respiratory depression
  • History of opioid use and tendency to coma
  • Accidental drug ingestion in a child
  • Sudden deterioration in a chronic pain patient
  • Polypharmacy and respiratory failure
  • Suspected illicit substance use

Treatment Methods

01
Securing airway patency
02
Bag-valve-mask ventilation
03
Naloxone 0.4–2 mg IV/IM/IN
04
Intranasal 4 mg (lay person rescuer)
05
Repeat after 2–3 minutes if no response
06
Up to a total dose of 10 mg
07
Short half-life, observation 4–6 hours
08
Higher doses in fentanyl cases
09
Referral to rehabilitation

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.