Naloxone nasal spray
NARCAN
Pronunciation: nal-OX-oen (NAR-kan)
“Nail-locks (Narcotic antagonist)”
dilated pupils → opioid blocker
What it isNaloxone 4 mg nasal spray (NARCAN, 2015; OTC since 2023) is a mu-opioid antagonist for community reversal of opioid overdose.
Why this oneA ready-to-use, needle-free device lets bystanders restore breathing before emergency clinicians arrive.
What limits itIt precipitates abrupt withdrawal in opioid-dependent people, and its intranasal half-life ~2 h may be shorter than the opioid's; repeat dosing and emergency care remain essential.
FDA-approved for
- opioid overdose (community reversal) (2015)
- nonprescription (OTC) status (2023)
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityUsually well tolerated; abrupt opioid withdrawal can cause severe agitation, vomiting, hypertension and pulmonary complications.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Emergency treatment of known or suspected opioid overdose | Adults and pediatric patients | 4 mg (1 spray) intranasally in one nostril | repeat every 2–3 minutes in alternating nostrils until response | No stated maximum — continue until patient responds or emergency help arrives |
Renal Undefined
Hepatic Undefined
Repeat every 2–3 minutes until the person responds or emergency help arrives
Instructions
- For nasal use only; do not test device before use
- Each device delivers one dose (single spray)
- Insert nozzle into either nostril and press plunger firmly
- Call 911 immediately after the first dose
- Repeat every 2–3 minutes with a new device in alternating nostrils if no response; keep giving until the person responds or help arrives
Available strengths
- nasal spray 4, 8, 3 mg/spray (4 Narcan · 8 Kloxxado · 3 RiVive OTC)
Cautions
- On waking, some people may experience opioid withdrawal symptoms such as shaking, sweating, nausea, or feeling angry (expected)
Adverse reactions
- Opioid withdrawal symptoms on waking (shaking, sweating, nausea, feeling angry)
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 4 mg/spray | nasal spray | per unit | $17.18/ea | — | offered |
| 8 mg/spray | nasal spray | per unit | — | $59.77/ea | not offered |
| 3 mg/spray | nasal spray | per unit | — | not offered |
Other forms: Naloxone
Available combined with: Buprenorphine/ naloxone (SUBOXONE)
Open Naloxone nasal spray in the interactive console ↗
Memory aids: interaction avatars
Open Naloxone nasal spray in the interactive console ↗
Self-check
- What naloxone dose does the NARCAN nasal spray contain?
4 mg. - Does initial response to nasal naloxone remove the need for emergency care?
No.