NaloxoneNaloxone Hydrochloride

About Naloxone

Naloxone is an opioid antagonist: it competes with opioids for the same receptors and reverses the slowed breathing, sedation and low blood pressure of an overdose. It is for the emergency treatment of known or suspected opioid overdose in adults and children. The 4 mg Narcan spray was approved for sale without a prescription in March 2023, the 3 mg RiVive spray in July 2023 and the 4 mg Rextovy spray in June 2026. The label steps are to give one spray into a nostril, call 911, repeat every 2 to 3 minutes with a new device if the person does not wake, and stay until help arrives, even if they wake up.

There is no boxed warning; the prescription labels list only an allergy to naloxone or the product’s ingredients as a reason not to use it. Naloxone can wear off before some opioids do, so breathing can slow again after the person wakes, which is why staying and repeating doses matters, and reversal of buprenorphine or pentazocine may be incomplete. In someone dependent on opioids it brings on sudden withdrawal, such as body aches, vomiting, fever or a fast heartbeat, and the nonprescription label says shaking, sweating, nausea or anger on waking is to be expected; in a newborn, withdrawal can be life-threatening. Headache, nasal dryness or congestion and muscle pain are among the side effects listed for the generic 4 mg spray.

The FDA states that naloxone has no abuse potential and is not a controlled substance. Storage differs by product: Narcan is kept at 36°F to 77°F (2°C to 25°C), so it may be refrigerated, but never frozen; RiVive is kept at 68°F to 77°F and not refrigerated. Replace any device by the expiration date on the package; in 2024 the FDA extended the shelf life of newly made Narcan 4 mg spray from three to four years. Injections come as generic vials and as Zimhi, a 5 mg prefilled syringe injected into the outer thigh, into the muscle or under the skin; the Evzio auto-injector and the brand Narcan injection are discontinued.

Taking Naloxone

How to take it

If the person will not wake when you shout and shake them gently, hold the spray with your thumb on the plunger, put the nozzle in either nostril and press firmly; do not test it first. Call 911 right after the first dose. If they do not wake within 2 to 3 minutes, give another dose with a new device, and repeat every 2 to 3 minutes.

If you miss a dose

Naloxone is used only in an emergency, so there is no schedule or missed dose. Give another dose if the person becomes very sleepy again; you may need every device in the pack.

Storage

Within the temperature range printed on the package, away from heat above 104°F (40°C); do not freeze Narcan, Kloxxado or Zimhi, keep them from light, and do not use a spray whose blister is open or torn.

Interactions to know about

It can bring on sudden withdrawal in anyone physically dependent on opioids, and reversal of buprenorphine or pentazocine may be incomplete. It does not reverse slowed breathing caused by non-opioid drugs, so emergency care is still needed.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Naloxone differs from pharmacy to pharmacy

Nonprescription sprays are shelf products: the store sets the price and there is no dispensing fee. A spray filled against a prescription, such as Kloxxado, Rezenopy or a generic 4 mg spray, is priced like any other prescription, with a fee. RiVive, Kloxxado, Rezenopy and the generic 4 mg spray come two devices to a carton, while Narcan comes in several carton sizes. Generic injection vials cost pharmacies little but are often packed in cartons of 10 or 25, so a pharmacy may need to order the form prescribed.

Ways to pay less for Naloxone without insurance

• Buy a 4 mg or 3 mg nasal spray off the shelf without a prescription, and ask which brands and pack sizes the pharmacy stocks.
• Ask your local health department or a community program whether it gives out naloxone at no charge.
• If Kloxxado or Rezenopy is prescribed, ask the prescriber whether a nonprescription 4 mg spray would suit you.
• If an injection is prescribed, confirm whether generic vials or Zimhi was intended and that the pharmacy stocks it.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Naloxone

1. 1.Which naloxone spray do you sell without a prescription, and how many devices are in a pack?
2. 2.How do I recognize an overdose, and what do I do after the first dose?
3. 3.Will it work if the person took buprenorphine or a long-acting opioid?
4. 4.Where should I keep it in hot or cold weather, and when does mine expire?

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