NEODOSE

INDICATIONS

• Narcotic antagonist: Narcotic antagonist Adjuvant therapy to customary resuscitation efforts for narcoticinduced respiratory (CNS) depression. Naloxone is not recommended as part of the initial resuscitation of newborns with respiratory depression in the delivery room. Before naloxone is given, providers should restore heart rate and color by supporting ventilation. The American Heart Association (AHA) did not review the use of naloxone in the 2015 Neonatal Resuscitation guidelines; therefore, the 2010 AHA guidelines still apply

INDICATIONS

• Injection: Indicated for complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids, and certain mixed agonistantagonist analgesics. Also indicated for diagnosis of suspected or known acute opioid overdose. Diagnosis of suspected or known acute opioid overdose.
• IM/subQ Injection; Nasal Spray: Indicated for emergency treatment known or suspected opioid overdose. It is intended for immediate administration as emergency therapy in setting where opioids may be present. In settings such as in neonates with known or suspected exposure to maternal opioid use, when it may be preferable to avoid the abrupt precipitation of opioid withdrawal symptoms, consider use of an alternate-containing product that can be dosed according to weight and titrated to effect. Also, in situations where the primary concern is for infants at risk for opioid overdose, consider whether the availability of alternate naloxone-containing products may be better suited than naloxone nasal spray

CONTRAINDICATIONS/PRECAUTIONS

May result in acute abstinence syndrome, manifested as convulsions, excessive crying, and hyperactive reflexes. Opioid withdrawal may be life-threatening in neonates. Recurrence of respiratory and/or CNS depression may occur following an initial improvement in symptoms.

ADVERSE EFFECTS

No short-term toxicity observed. One case report of seizures secondary to acute opioid withdrawal after administration to an infant born to an opioid abuser. Long-term safety has not been investigated.

ADMINISTRATION

IV Injection

Recommended route is IV push. IM or subQ administration is not recommended in children due to erratic and unpredictable absorption. May also be given via intraosseous access for emergent pediatric resuscitation.

IM or subQ Injection-Evzio(R)

Use the provided printed or electronic voice instruction for administration. If electronic voice instruction does not operate, the dose can still be delivered. Do not attempt to replace the red safety guard. Once removed, administer the dose immediately or discard unused dose. Administer IM into anterolateral aspect of the thigh. For children younger than 1 year, pinch the thigh during administration. Immediately after administration, call for emergency help and keep the patient under continuous surveillance.

Nasal route

Patient should be in a supine position for administration. Do not prime or test the device prior to use. Administer into alternate nostrils with each dose. Do not reuse a Narcan(R) nasal spray, a new nasal spray must be used for each dose. Turn patient onto their side after administration of the first dose.

MONITORING

Assess respiratory effort and neurologic status. Monitor patient for 24 hours for relapse. Monitor for signs of acute withdrawal, including convulsion, excessive drying, and hyperactive reflexes. Monitor blood pressure and ECG, and the development of pulmonary edema in patients with pre-existing cardiac disease or use of medications having adverse cardiovascular effects.