Narcan (Naloxone) Approved for Over-the-Counter Use

As of March 29, 2023, the U.S. Food and Drug Administration approved Narcan, 4 mg. naloxone hydrochloride nasal spray for non-prescription use. The brand name Narcan was first approved by the FDA in 2015 as a prescription drug to rapidly reverse the effects of opioid overdose.  With national figures climbing yearly for the rate of overdose deaths, driven primarily by synthetic opioids like fentanyl, there is reason for a larger supply of naloxone to be available to consumers in places like drug stores, convenience stores, gas stations, vending machines, and online.

What is in it and how does it work?

An overdose occurs when too much of an opioid fits into too many brain receptors slowing, then stopping, a person’s breathing.  Naloxone, an opioid antagonist, has a stronger attraction to these receptors than many opioids than many opioids so it can knock the opioids off the receptors for a short time.  By reversing an overdose, the person can breathe again.

The effect is temporary and wears off in 30-90 minutes. The breathing problems and sleepiness could return. Always call for emergency help after the first dose of Naloxone. Narcan does not cause euphoria and is used only for emergencies.  Some types of opioid medications (e.g. bupreorphine, pentazocine) may require repeat doses of naloxone to reverse the opioid’s effects. If it is given to someone who did not overdose on opioids, then it will not harm the person; it just won’t have any effects.

This medicine has to be administered to the patient by someone else.  It is only to be used in the nose.  If it gets on other body areas, wash the affected areas immediately.

How do I Keep It?

It is found to be chemically stable for ten months after its labelled expiration date.  It should be stored at a controlled room temperature 68 degrees F to 77 degrees F, away from heat, moisture, and direct light.  It should not be kept in a refrigerator or in a car.  However, if the spray is frozen, it can be thawed for 15 minutes in room temperature, and it can still be used if it has been thawed after being frozen before.

What Are The Side Effects?

• Agitation
• Body Aches
• Crying more than usual (in babies)
• Fast, pounding or irregular heartbeat or pulse
• Goose bumps
• Loss of Consciousness
• Nausea or vomiting
• Trouble breathing
• More severe symptoms include a fever, sweating, runny nose, sneezing, yawning, weakness, nervousness, diarrhea, shivering or trembling, stomach cramps.
• Less common side effects include discomfort in the nose, lack of strength, lightheadedness, dizziness, fainting.

How Much Do I Give To The Patient

The dose of this medicine varies according to the patient.  Either follow your doctor’s orders or the label directions.  The following information applies only to the average doses of Narcan.  If your dose is different, unless the doctor tells you to do so, do not change it.  For nasal dosage form (Narcan spray) for adults and children:  At first, 2 or 4 milligrams (1 spray into one nostril).  Another spray may be given into the other nostril every 2 to 3 minutes until the patient responds or until emergency medical assistance becomes available.

To administer the nasal spray:

• Remove the nasal spray from the box.  Peel back the tab with the circle to open it.
• Do not prime or test the nasal spray.  It contains a single dose of naloxone and cannot be reused.
• Hold the nasal spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
• Lay the patient on their back.  Support the patient’s neck by your hand and allow the head to tilt back before giving this medicine.
• Gently insert the tip of the nozzle into one nostril of the patient, until your fingers on either side of the nozzle are going against the bottom of the patient’s nose.
• Press the plunger firmly to give the dose.  Remove the nasal spray from the patient’s nostril after giving the dose.
• Move the patient on their side (recovery position) after giving the medicine and get emergency medical help immediately.
• Watch the patient closely.  You may also give additional doses to the patient every 2 to 3 minutes until the patient responds or emergency medical assistance becomes available.

The Cost

As of last month, some harm-reduction groups say the discounted price is approximately $47 for a 2 pack of Narcan brand spray.  For under $50, you can save a life!

Sources:  Mayo Clinic, US FDA, Washington Post