Palliative Care Guidelines - NHS Lanarkshire

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Palliative Care Guidelines: NaloxoneNaloxone in Palliative CareDescriptionAntagonist for use in severe opioid induced respiratory depression.Preparation• 400 micrograms/ml injection (1ml ampoule).Indications• Reversal of life-threatening respiratory depression due to opioid analgesics, indicated by:• A low respiratory rate < 8 respirations/minute.• Oxygen saturation
Palliative Care Guidelines: NaloxoneDose & AdministrationProlonged or recurrent, opioid induced respiratory depression:• If repeated naloxone doses are required, start a continuous intravenous infusion of naloxonevia an adjustable infusion pump.• Add 1mg of naloxone (= 2.5ml of 400 micrograms/ml naloxone injection) to 100ml ofsodium chloride 0.9% to give a concentration of 10 micrograms/ml.• Calculate the dose requirement per hour by totalling the naloxone bolus doses anddividing by the time period over which all the doses have been given.• Start the IV infusion of naloxone at half this calculated hourly rate.• Adjust the naloxone infusion rate to keep the respiratory rate above 8 (do not titrate tothe level of consciousness).• Continue to monitor the patient closely.• Continue the infusion until the patient’s condition has stabilised.• Additional IV boluses may need to be given using naloxone diluted in sodium chloride 0.9% asabove.If in doubt, seek advice• Seek and treat the precipitating cause(s) of the opioid toxicity.• Review the regular analgesic prescriptions.Good Practice Point• Naloxone should be available in all clinical areas where opioids are used.(National Patient Safety Agency)• Naloxone is also available in disposable, pre-filled syringes. These doses may be too high forpatients on regular opioid analgesics.ResourcesProfessionalPalliative Care Drug Information online http://www.palliativedrugs.com/Community use• Naloxone may be administered IM when IV access is not immediately available• 100 micrograms (0.25ml) naloxone IM should be given and repeated after five minutes if thereis no improvement with the first dose.• An IV line should be sited as soon as possible.Key references1. Twycross R, Wilcock A. Palliative Care Formulary (3 rd Edition) 2007, Palliativedrugs.com Ltd., Nottingham2. National Patient Safety Agency. Safer practice notice 2006/123. Adult Emergencies Handbook. NHS Lothian: University Hospitals Division.4. Electronic Medicines Compendium. www.medicines.org.uk/naloxone http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&documentid=647 18/6/075. Lothian Joint Formulary. Section 15.1.7. www.ljf.scot.nhs.uk2 Issue date: January 2009 Review date: March 2012 © NHS Lothian
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Palliative Care Guidelines - NHS Lanarkshire

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