Naloxone Nasal Spray

(nal ox' one)

Brand Name(s): Kloxxado^®, Narcan^®, Rezenopy^®; also available generically

WHY is this medicine prescribed?

Prescription and nonprescription (over the counter) naloxone nasal spray is used along with emergency medical treatment to reverse the life-threatening effects of a known or suspected opiate (narcotic) overdose in adults and children. Naloxone nasal spray is in a class of medications called opiate antagonists. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Naloxone comes as a solution (liquid) to spray into the nose. It is usually given as needed to treat opiate overdoses. Each naloxone nasal spray contains a single dose of naloxone and should be used only once.

You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone nasal spray, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. You and anyone who may need to give the medication should read the instructions that come with the nasal spray. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions.

You should keep the nasal spray available at all times in case you experience an opioid overdose. Be aware of the expiration date on your device and replace the spray when this date passes.

Naloxone nasal spray may not reverse the effects of certain opiates such as buprenorphine (Belbuca, Buprenex, Butrans, Sublocade) and pentazocine (Talwin) and may require additional naloxone doses with a new nasal spray each time.

Symptoms of an opioid overdose include excessive sleepiness, not awakening when spoken to in a loud voice or when the middle of your chest is rubbed firmly, shallow or stopped breathing, or small pupils (black circles in the center of the eyes). If someone sees that you are experiencing these symptoms, he or she should give you your first naloxone dose and then call 911 immediately. After receiving the naloxone nasal spray, a person should stay with you and watch you closely until emergency medical help arrives.

To give the inhaler, follow these steps:

1. Lay the person on their back to give the medication.
2. Remove the naloxone nasal spray from the box. Peel back the tab to open the spray.
3. Do not prime the nasal spray before using it.
4. Hold the naloxone nasal spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
5. Gently insert the tip of the nozzle into one nostril, until your fingers on either side of the nozzle are against the bottom of the person's nose. Provide support to the back of the person's neck with your hand to allow the head to tilt back.
6. Press the plunger firmly to release the medication.
7. Remove the nasal spray nozzle from the nostril after giving the medication.
8. Turn the person on their side (recovery position) and call for emergency medical assistance immediately after giving the first naloxone dose.
9. If the person does not respond by waking up, to voice or touch, or breathing normally or responds and then relapses, give another dose. If needed, give additional doses (repeating steps 2 through 7) every 2 to 3 minutes in alternate nostrils with a new nasal spray each time until emergency medical assistance arrives.
10. Put the used nasal spray(s) back in the container and out of reach of children until you can safely dispose of it.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

What SPECIAL PRECAUTIONS should I follow?

Before receiving naloxone nasal spray,

• tell your doctor and pharmacist if you are allergic to naloxone, any other medications, or any of the ingredients in naloxone nasal spray. Ask your pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to tell your doctor about all the medications you are taking.

• tell your doctor if you have or have ever had heart disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you receive naloxone nasal spray during pregnancy, your doctor may need to monitor your unborn baby carefully after you receive the medication.

What SIDE EFFECTS can this medicine cause?

Naloxone nasal spray may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• nasal dryness, nasal swelling, or congestion
• muscle pain
• change in sense of taste
• stomach pain

Some side effects can be serious. If you experience any of these symptoms, get emergency medical treatment:

• signs of opiate withdrawal such as body aches, diarrhea, fast, pounding, or irregular heartbeat, fever, runny nose, sneezing, sweating, yawning, nausea, vomiting, nervousness, restlessness, irritability, shivering, trembling, stomach cramps, weakness, and the appearance of hair on the skin standing on end
• seizures
• loss of consciousness
• crying more than usual (in babies treated with naloxone nasal spray)
• stronger than normal reflexes (in babies treated with naloxone nasal spray)

Naloxone nasal spray may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom). Do not freeze the naloxone nasal spray.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What OTHER INFORMATION should I know?

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: July 20, 2024.