What is the starting dose of naloxone for suspected opioid overdose, and how should it be titrated?

• A. 0.4 mg IV; titrate to achieve adequate respiration; may require higher doses
• B. 2 mg IV; fixed dose
• C. 0.1 mg IV; titrate to respiration
• D. 1 mg IV; single dose only

Answer: (A)

Naloxone works by competing with opioids at mu receptors to reverse the respiratory depression they cause. To do this safely, start with a small IV bolus of 0.4 mg and immediately reassess the patient’s breathing and mental status. If respiration remains inadequate, give additional naloxone in small increments (for example, another 0.4 mg every 2–3 minutes) until adequate ventilation is achieved. Higher total doses may be needed for potent or long-acting opioids, or when there is high receptor occupancy, but always titrate to response rather than using a fixed large dose. This approach minimizes the risk of precipitating withdrawal and other complications while ensuring the patient regains breathing.