Narcan with negative tox screen

GrumpyRN, NP · Jan 20, 2015

Used to say about Narcan, "if you think about it give it". Not going to do any harm and may perhaps reverse cause of reduced consciousness.

Yes, yes, I know. Not very scientific and not a whole heap of evidence but.......

RainMom · Jan 20, 2015

Yeah that's kind of what we're coming up with here. ER wasn't sure what was going on with the pt & must have decided to try it. But a second dose of 2 mg? [shrugs]

Loo17 · Jan 20, 2015

Yeah that's kind of what we're coming up with here. ER wasn't sure what was going on with the pt & must have decided to try it. But a second dose of 2 mg? [shrugs]

They probably thought that there was a slight change in mental status with the initial smaller dose so they went for the gusto with the 2mg dose. Plus if there was a chance the patient OD'ed on Suboxone, that does not show up in the basic tox panel.

loriangel14, RN · Jan 20, 2015

I recently administered NARCAN on the floor with no tox screen done. We gave it and she responded. Later neded another dose.

allnurses Guide · Jan 21, 2015

Other than the fact that you could cause an MI, CVA, convulsions, HTN crisis etc. from sudden withdrawal by giving Narcan..Narcan Side Effects in Detail - Drugs.com

Narcan is not a drug that should be given just because.

Loo17 · Jan 21, 2015

Other than the fact that you could cause an MI, CVA, convulsions, HTN crisis etc. from sudden withdrawal by giving Narcan..Narcan Side Effects in Detail - Drugs.com
Narcan is not a drug that should be given just because.

I am very sure that all those things are possible not sure it would happen with a single 2mg dose, especially if there was minimal reaction from 0.4mg. Obviously a provider would need to weigh the options prior to ordering it. If the patient has a history of drug abuse or there is potential that their symptoms are related to a drug overdose it is not uncommon or it to be given in the emergency setting. Also if a patient has received multiple narcotic doses and then suddenly becomes lethargic with decreased respirations it is given in smaller doses.

RainMom · Jan 21, 2015

Those of us on the floor just found it to be extremely odd to give narcan after getting neg lab results. This was an OTR truck driver & perhaps there was something in his system that wasn't picked up on a tox screen but is there anything besides narcs/opiates that respond to narcan I'm not aware of?

GrumpyRN, NP · Jan 21, 2015

Other than the fact that you could cause an MI, CVA, convulsions, HTN crisis etc. from sudden withdrawal by giving Narcan..Narcan Side Effects in Detail - Drugs.com

You did look at those references didn't you? They ranged from 1977 to 2001 and only one was in this century. Just a tad out of date....

Also, using references which describe the use of Naloxone as a TREATMENT is not what this discussion is about. We (or at least I) was discussing using it in a small dose 200 -400 microgrammes) to reverse a possible cause of acute reduced consciousness.

Loo17 · Jan 21, 2015

Those of us on the floor just found it to be extremely odd to give narcan after getting neg lab results. This was an OTR truck driver & perhaps there was something in his system that wasn't picked up on a tox screen but is there anything besides narcs/opiates that respond to narcan I'm not aware of?

Suboxone responds to Narcan. If a patient overdoses or takes Suboxone it does not show up on the standard opiate toxicology screen.

The standard urine tox for opiates detects morphine metabolites. There are many drugs it wont necessarily detect-fentanyl, hydrocodone, tramadol, etc. The expanded panel is not routinely ordered and the results take much longer to be obtained. Meaning if a doctor suspects that a patient is altered from the drug it would be quicker to try narcan and hopefully see an improvement versus wait until the following day to get the results. Then if there is no change they can cross that off as a possible cause and move on.

chare · Jan 22, 2015

â€¦Narcan is not a drug that should be given just because.

From the For Professionals tab of your reference:

Narcan is indicated for the complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids, including propoxyphene, methadone and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, butorphanol, and cyclazocine. Narcan is also indicated for diagnosis of suspected or known acute opioid overdosage.

Other than the fact that you could cause an MI, CVA, convulsions, HTN crisis etc. from sudden withdrawal by giving Narcanâ€¦

Sure, this is possible, if you slam a dose of Narcan and completely reverse the narcotic effects. Maybe I'm a dinosaur, but I was taught to dilute the dose to 10 mL, slowly administer it, and titrate to an improvement in respiratory status.

allnurses Guide · Jan 22, 2015

I understand that and using Narcan even in those doses I have seen acute HTN and severe uncontrollable pain caused from the sudden reversal of opioids. That is why in anesthesia we are taught to dilute Narcan and titrate it to effect.