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Healthcare Professional

Identify opioid overdose

Prenoxad Injection (naloxone hydrochloride 1mg/1ml solution for injection) should only be used in an emergency situation where it is known or suspected that an overdose has occurred and opioid drugs may be involved.

The signs and symptoms of an opioid overdose are:

  • Pinpoint pupils (indicates opiod use)
  • Pale skin colour
  • Bluish tinge to lips, tip of nose, eye bags, fingertips or nails
  • No response to noise (where the helper ‘shouts’ at suspected casualty and gets no response)
  • No response to touch (where the helper shakes the suspected casualty by the shoulders and gets no response)
  • Loss of consciousness i.e. the suspected overdose casualty cannot be woken
  • Breathing problem
    • Slow/shallow or infrequent breaths
    • Snoring/rasping sounds
    • Not breathing at all

Approach the suspected casualty with caution and care, watching out for anything that might be dangerous to you or the casualty. These dangers may vary depending on where the suspected casualty has been found i.e. outside (there may be broken glass on the ground, traffic nearby, etc) or indoors in a home environment (close to a fire/heat source, cables, wires etc). It may also be the case that other potential dangers could be present, such as injecting equipment (needles/syringes etc). If you see a needle or syringe near the casualty and it may pose a threat to you or the casualty if you need to move them (for example) into the recovery position, then you may need to move the injecting equipment safely.

MAKE SURE IT IS SAFE FOR YOU TO APPROACH THE CASUALTY BEFORE YOU DO SO.

You should begin by speaking to the casualty from a safe distance, saying “open your eyes” or “wake up”. If there is no response to this, start to use a louder voice (shouting), making the same statements to the casualty. As you continue to approach, keep looking out for dangers and continue to use your voice like this.

Once you are next to the casualty try to get a response from them by shaking their shoulders and shouting “open your eyes” or “wake up” into each ear. If they don’t wake or respond, you may need to move them from a sitting position, or if they are lying on a sofa/ in a bed onto the floor. Once the casualty is lying on a flat surface, make sure you open their airway by gently tilting their head back and opening their mouth. Look, listen and feel for signs of breathing for no more than 10 seconds.

What you do next depends on whether the person is breathing or not.

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Prescribing Information for Prenoxad 1mg/ml Injection

Please refer to Summary of Product Characteristics before prescribing.

Presentation: A 2ml pre-filled syringe containing Naloxone Hydrochloride 1mg/ml.


Indications: Prenoxad Injection is intended for emergency use in the home or other non-medical setting by appropriate individuals or in a health facility setting for the complete or partial reversal of respiratory depression induced by natural and synthetic opioids, including methadone, diamorphine (dicetylemorphine (INN)) and certain other opioids such as dextropropoxyphene and certain mixed agonist/antagonist analgesics: nalbuphine and pentazocine. Prenoxad Injection should be carried by persons at risk of such events. It may also be used for the diagnosis of suspected acute opioid overdose.


Dosage and Administration: : Prenoxad Injection may only be made available once the prescriber has assessed the suitability and competence of a client or representative to administer Naloxone in the appropriate circumstances. Prenoxad Injection is for administration by intramuscular injection.


Adults and the Elderly: Opioid overdosage (known or suspected). For Use by individuals in the community.
In patients where breathing does not appear to be normal.
In patients where breathing does not appear to be normal administration of Prenoxad Injection should be preceded by calling emergency services and requesting an ambulance. Following this, 30 chest compressions and if possible 2 rescue breaths (Basic Life Support SINGLE CYCLE) should be given; 0.4ml Prenoxad Injection solution should then be administered by intramuscular injection into the outer thigh muscle or muscles of the upper arm, through clothing if necessary. A further 3 cycles of chest compressions and rescue breaths should then be given followed by administration of 0.4ml Prenoxad Injection. Three cycles of chest compression and rescue breaths should take approximately 2 minutes. This should be repeated until an ambulance arrives or the patient begins breathing normally / regains consciousness. The patient when breathing normally or has regained consciousness should be placed in the recovery position (lying on their side, mouth open pointing towards the ground) and observed continuously.


In patients were breathing is normal but the patient is unrousable or suspected to be unconscious. The patient should be placed in the recovery position. 0.4ml Prenoxad Injection solution should be administered by intramuscular injection into the outer thigh muscle or muscles of the upper arm, through clothing if necessary, and an ambulance should be called. 0.4ml Prenoxad Injection solution should then be administered every 2-3 minutes and continued until the ambulance arrives and or the patient regains consciousness.


Children and Neonates: The Prenoxad Injection presentation is not intended to be used for children in the home setting other than by an appropriately trained healthcare professional.


Contra-Indications: Known hypersensitivity to Naloxone or any of the ingredients.


Warnings And Precautions: Prenoxad Injection is intended as an emergency treatment and the patient should be advised to seek medical help immediately.It should be administered cautiously to patients who have received large doses of opioids or to those physically dependent on opioids since too rapid reversal of opioid effects by Prenoxad may precipitate an acute withdrawal syndrome in such patients. Patients who have responded satisfactorily to Prenoxad should be kept under medical observation for at least 2 hours. Repeated doses of Prenoxad may be necessary since the duration of action of some opioids may exceed that of Prenoxad. Use with caution in patients with pre-existing cardiac, hepatic or renal disease and in those receiving medications with potential adverse cardiovascular effects e.g. hypotension, ventricular tachycardia or fibrillation and pulmonary oedema. Caution should be exercised and patients monitored when Prenoxad Injection is administered to this patients with renal insufficiency/failure or liver disease.


Interactions: Administer cautiously to opioid dependent patients including newborns of mother’s dependant or those suspected of having received large doses and observe for signs of acute withdrawal.


Pregnancy and Lactation:Prenoxad should be used with caution in pregnancy. The neonate must also be monitored for signs of opioid withdrawal. Naloxone may be administered during the second stage of labour to correct any respiratory depression due opioid analgesics. It is not known whether Naloxone is excreted in human milk therefore use with caution in breastfeeding mothers.


Undesirable Effects:Common side effects include nausea, vomiting, dizziness, headache, ventricular tachycardia, hypotension and hypertension. Less common side effects: Tremor, sweating, arrhythmia, bradycardia, diarrhoea, dry mouth, hyperventilation, inflammation. Seizure tension, allergic recations, anaphylactic shock, fibrillation, cardiac arrest, erythema multiforme, fever, dyspnoea, runny nose, sneezing and yawning. Piloerection, weakness, shivering.


Product Licence Number: PL 12064/0125 Product Licence Holder: Aurum Pharmaceuticals Ltd, Bampton Road, Harold Hill, Romford, Essex RM3 8UG Basic NHS Price: £18.00 Legal Category: POM. Date of Preparation: April 2013


For more details contact: Aurum Pharmaceuticals ubert Road, Brentwood, Essex CM14 4LZ 01277 266600


Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Martindale Pharma Tel. 01277 266600 Fax 01708 382739 e-mail drugsafety@martindalepharma.co.uk