Reference

Naloxone Administration Quick Reference

One-page reference for recognizing opioid overdose and giving naloxone.

In any suspected overdose, call 911.

Recognize

Likely opioid overdose

Will not wake to a loud voice or sternal rub.
Breathing is slow, shallow, gasping, or absent (about 10 breaths/min or fewer).
Pinpoint pupils.
Bluish, grey, or unusually pale lips, fingertips, or face.
Limp body, gurgling or snoring sound from the throat.

Looks like something else

Awake and talking, breathing normally — opioid overdose is unlikely right now.
Large pupils, agitation, sweating without sedation — think stimulant.
Smell of alcohol but normal breathing rate — likely alcohol intoxication, not overdose.

When opioid overdose is possible, give naloxone. Naloxone will not reverse non-opioid sedation, but do not delay EMS.

Give

Use whatever product is in front of you. All of these reverse opioids; each pre-packaged unit is a single dose, so there is no dose to calculate. Pick the product you have on hand:

4 mg intranasal naloxone

e.g., Narcan and generics; sold over the counter since 2023.

One dose

One spray in one nostril = one full dose (4 mg / 0.1 mL).

Onset

2–3 min

Duration

30–90 min

How to give

Tilt the person's head back and support the neck with one hand.
Place the tip of the spray into one nostril until your fingers touch the bottom of the nose.
Press the plunger firmly all the way in. The full device delivers one dose.
Do not test the spray before use — there is only one dose per device.

Print includes the selected product only. Select a different product before printing its instructions.

Repeat & Wait

No response in 2–3 minutes? Give another dose. For intranasal, alternate nostrils. Repeat every 2–3 minutes until the person breathes on their own or EMS arrives.
More than one dose may be needed, especially with potent or long-acting opioids. Keep dosing every 2–3 minutes if there is no response.
Between doses: if trained, give rescue breaths. Once breathing returns, roll the person onto their side with the top knee bent forward and head tilted back (recovery position) to protect the airway from vomit.
Call 911 as soon as possible. Do not leave to make the call if anyone else can do it for you.

0 min

Give first dose.

2–3 min

No response? Give another dose.

0–30 min

Onset and peak effect.

30–90 min

Naloxone wearing off.

Hours

Long-acting opioid may still be on board.

After They Wake Up

Stay with them. Call 911 even if they refuse transport. Most opioids outlast naloxone, so re-sedation is possible after 30–90 minutes.
Follow local protocol for observation after the last dose; longer monitoring is needed for methadone, extended-release opioids, fentanyl patches, or any counterfeit pill of unknown origin.
Expect withdrawal: vomiting, sweating, agitation, body pain, diarrhea in opioid-tolerant patients. Usually not life-threatening in otherwise healthy adults, but vomiting, agitation, pregnancy, and medical comorbidity require monitoring.
Naloxone does not reverse benzodiazepines, alcohol, stimulants, or xylazine. If breathing improves but the person stays unresponsive, EMS is still needed — they may have a co-ingestion.
Pregnancy: give naloxone for suspected opioid overdose. Untreated overdose can endanger both the pregnant patient and fetus; after stabilization, maternal/fetal monitoring is needed.
Offer rapid linkage to ongoing care after reversal. Methadone and buprenorphine reduce overdose and mortality risk; a prescriber can discuss options.

Always call 911 for a suspected overdose

Even if the person wakes up and refuses transport, re-sedation can happen once naloxone wears off. Stay with them and keep them in the recovery position until EMS arrives.

Good Samaritan note: Most U.S. states have laws that protect people who call 911 for an overdose from minor drug-possession charges. Specifics vary by state.

General information, not medical or legal advice. This summarizes publicly available U.S. FDA product labeling and SAMHSA guidance for emergency naloxone use, and is not a substitute for clinical judgment, your facility protocol, or the directions on the product you are holding.