What is a typical initial naloxone dosing strategy for suspected opioid overdose?

• A. 0.4 mg to 2 mg IM/IV/IN
• B. 10 mg IV push
• C. 0.01 mg intradermal
• D. 5 mg subcutaneous

Answer: (A)

Naloxone works by quickly displacing opioids from receptors, so the best approach is to reverse the overdose with a small, titratable dose and then adjust based on the patient’s response. A typical initial amount is in the modest range, given by IV, IM, or intranasal routes, with the dose repeated every couple of minutes as needed until breathing improves and mental status returns. This titration helps restore ventilation while reducing the risk of precipitating withdrawal or agitation. IV delivers the fastest effect, IM is reliable in the field, and intranasal offers a convenient alternative. If needed, you can increase the total dose in small steps, but starting with a very large single dose or an extremely tiny dose is not consistent with safe, effective reversal. Monitor closely for re-narcotization and provide airway support as needed.