Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose

Acad Emerg Med. 1998 Apr;5(4):293-9. doi: 10.1111/j.1553-2712.1998.tb02707.x.


Objective: To determine whether naloxone administered i.v. to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (s.q.).

Methods: A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out-of-hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate > or =10 breaths/min, and durations of bag-valve-mask ventilation. Subjects received either naloxone 0.4 mg i.v. (n = 74) or naloxone 0.8 mg s.q. (n = 122), for respiratory depression of <10 breaths/min.

Results: Mean interval from crew arrival to respiratory rate > or =10 breaths/min was 9.3 +/- 4.2 min for the i.v. group vs 9.6 +/- 4.58 min for the s.q. group (95% CI of the difference -1.55, 1.00). Mean duration of bag-valve-mask ventilation was 8.1 +/- 6.0 min for the i.v. group vs 9.1 +/- 4.8 min for the s.q. group. Cost of materials for administering naloxone 0.4 mg i.v. was $12.30/patient, compared with $10.70/patient for naloxone 0.8 mg s.q.

Conclusion: There was no clinical difference in the time interval to respiratory rate > or =10 breaths/min between naloxone 0.8 mg s.q. and naloxone 0.4 mg i.v. for the out-of-hospital management of patients with suspected opioid overdose. The slower rate of absorption via the s.q. route was offset by the delay in establishing an i.v.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Drug Overdose
  • Emergency Medical Services / economics
  • Female
  • Humans
  • Injections, Intravenous
  • Injections, Subcutaneous
  • Male
  • Naloxone / administration & dosage*
  • Naloxone / therapeutic use
  • Narcotic Antagonists / administration & dosage*
  • Narcotic Antagonists / therapeutic use
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / physiopathology
  • Prospective Studies
  • Respiration
  • Resuscitation*


  • Narcotic Antagonists
  • Naloxone