# Naloxone (Narcan)

Restore ventilation in suspected opioid toxicity; distinguish ALS routes from the BLS nasal-product pathway.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/naloxone/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- SO-B-002 is a separate BLS pathway for stocked equipment, including a 4 mg preloaded spray and a 2 mg atomizer method. Do not transfer ALS repeat-dose rules into the BLS instructions.
- Anticipate vomiting, agitation, and withdrawal after reversal. Continue airway and respiratory reassessment.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=4)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf)
- [SO-P-085 — Substance Overdose / Poisoning - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf)
- [SO-B-002 — Naloxone Administration](https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf)
- [325.00 — Advanced Life Support (ALS) Provider Unit Minimum Inventory](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/325.00%20ALS%20Minimum%20Equip%2010-2025.pdf)

## Use in OCEMS

- The ALS overdose pathway treats suspected opioid toxicity with respiratory depression, approximately 12 breaths/min or fewer.
- Support ventilation with BVM and suction as needed while treating the suspected cause.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| ALS IV | 0.4–1 mg IV; repeat every 3 minutes as needed to maintain adequate breathing. |
| ALS IM / IN solution | 0.8, 1, or 2 mg IM/IN; repeat every 3 minutes as needed. |
| Preloaded nasal product | I-15 directs the preloaded dose, repeating every 3 minutes as needed. Inventory 325.00 lists 4 mg/0.1 mL and optional 8 mg/0.1 mL products; verify the actual device and agency protocol. |

## Pediatric

- SO-P-085: 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose; repeat every 3 minutes as needed. It separately lists a preloaded 4 mg/0.1 mL nasal spray.
- Use the condition order’s maximum and the correct concentration; do not assume all prefilled or intranasal products have the same dose.

## Pediatric weight table — Suspected opioid toxicity with respiratory depression

- Source: SO-P-085. Dose rule: 0.1 mg/kg; route: IN/IM/IV.
- 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose; may repeat every 3 minutes as needed. Ventilation support comes first.
- The separate 4 mg/0.1 mL preloaded nasal spray is a fixed single-spray product. Do not use the syringe volumes below for that device.
- I-20 lists a rounded 0.8 mg dose for some 0.4 mg/mL product bands; these examples instead calculate the SO-P-085 0.1 mg/kg regimen with its 1 mg cap. Confirm the actual product and applicable order.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IN/IM/IV | Volume at 1 mg/mL | Volume at 0.8 mg/2 mL = 0.4 mg/mL |
| --- | --- | --- | --- |
| 3 kg | 0.3 mg | 0.3 mL | 0.75 mL |
| 4 kg | 0.4 mg | 0.4 mL | 1 mL |
| 5 kg | 0.5 mg | 0.5 mL | 1.25 mL |
| 6 kg | 0.6 mg | 0.6 mL | 1.5 mL |
| 8 kg | 0.8 mg | 0.8 mL | 2 mL |
| 10 kg | 1 mg | 1 mL | 2.5 mL |
| 12 kg | 1 mg | 1 mL | 2.5 mL |
| 15 kg | 1 mg | 1 mL | 2.5 mL |
| 20 kg | 1 mg | 1 mL | 2.5 mL |
| 25 kg | 1 mg | 1 mL | 2.5 mL |
| 30 kg | 1 mg | 1 mL | 2.5 mL |
| 35 kg | 1 mg | 1 mL | 2.5 mL |
| 40 kg | 1 mg | 1 mL | 2.5 mL |
| 45 kg | 1 mg | 1 mL | 2.5 mL |
| 50 kg | 1 mg | 1 mL | 2.5 mL |
| 60 kg | 1 mg | 1 mL | 2.5 mL |

## Preparation & reassessment

- For a nasal device, confirm product strength and follow that device’s instructions. For drawn-up solutions, verify mg/mL before selecting volume.
- Document respiratory response, repeated doses, and prior bystander administration; prepare transport and further ALS care.