Naloxone


Save a life with Naloxone

An opioid overdose can happen at anytime to anyone taking prescribed or illicit opioid medications. At CompreCare, we believe each and every patient, friend, family member or caregiver should be ready with accessible naloxone in order to reverse an opioid overdose and save a life.

Naloxone, also known as Narcan ® is available without a prescription in most of the US states CompreCare ships to. To find out if you can get naloxone without a prescription, call us at 1-888-644-8326 or email us at info@comprecarerx.com.

Naloxone is also available by prescription from a licensed prescriber in every state CompreCare services.


Available medications:

Narcan Nasal Spray 4mg (2-count 0.1mL sprays): Price: $160.99
(Includes nitrile latex-free gloves and instructions for use)

Naloxone kit 1mg/1mL (2-count 2mL syringe): Price: $115.99
(Includes 2 nasal spray adaptors, nitrile latex-free gloves and instructions for use)


How can I get Naloxone without a prescription?

Don’t have a prescription for Naloxone? Most states have made Naloxone available without a written prescription from a prescriber. Simply contact us, and a member of our staff will reach out to you to see if you qualify for naloxone without a written prescription.

Once ordered, our pharmacists will contact you to provide you with necessary instruction and counseling. Your order will also contain instructions on how to recognize an opioid overdose and how to use naloxone.

What is Naloxone?

Naloxone is the primary reversal agent for opioid medications. It is often described as an opioid antagonist because it competes with opioid medications, thereby reversing their effect. Naloxone is indicated for emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression or unconsciousness.

Who is at risk for an overdose?

The World Health Organization (WHO) Information Sheet on Opioid Overdose and CDC Guideline for Prescribing Opioids for Chronic Pain identify risk factors for opioid overdose:1,2

  • People who use prescription opioids, in particular those taking higher doses (≥50 morphine milligram equivalents [MME])
  • People who use opioids in combination with other sedating substances, such as benzodiazepines
    • People who use opioids and have medical conditions such as HIV, liver or lung disease, or suffer from depression
    • Household members of people in possession of opioids (including prescription opioids)
    • People with opioid dependence, in particular following reduced tolerance (following detoxification, release from incarceration, cessation of treatment)
    • People who inject opioids
How to respond to an overdose using naloxone3

Steps to identify and act on an opioid overdose:

Step 1: Identify the overdose and check responsiveness

Opioids can suppress breathing. If someone is not breathing or is struggling to breathe, try calling the person's name and rubbing your knuckles on their chest. If there's still no response, they could be experiencing an overdose.

Signs of overdose:

  • blue or pale skin color
  • small pinpoint pupils
  • low blood pressure
  • slow heartbeat
  • slow or shallow breathing
  • snoring sound
  • gasping for air

Step 2: Get help and Call 9-1-1

After identifying an overdose, call for help as quickly as possible. Call 9-1-1. Make sure to say the person is unresponsive and not breathing or struggling to breathe. Give a clear address and location of where you are.

Step 3: Perform Rescue Breathing

Giving oxygen can save someone experiencing an overdose. Perform basic CPR (Cardiopulmonary Resuscitation):

  1. Make sure nothing is in the person's mouth that can block breathing.
  2. Place one hand on the person's chin and tilt head back. Pinch their nose closed with the other hand.
  3. Administer 2 slow breaths and look for the person's chest to rise.
  4. Continue administering 1 breath every 5 seconds until the person starts breathing on their own.
  5. If the person is still unresponsive after repeating for 30 seconds, you can give naloxone.

Step 4: Administer naloxone

Follow the instructions for the form of naloxone you have - injectable or nasal spray. Don't forget to give rescue breaths while you prepare to administer naloxone.

After administering naloxone, continue giving rescue breaths, 1 breath every 5 seconds. If the person is still unresponsive in 2 to 3 minutes, you can give a second dose of naloxone. Continue breaths until emergency responders arrive.

Step 5: Stay until help arrives

Stay to make sure the person:

  • Doesn't go into withdrawal
  • Doesn't take more opioids, which could send them back into overdose
  • Doesn't go back into overdose and need additional doses of naloxone
  • Doesn't experience rapid or irregular heartbeat, chest pain, seizures, sudden stopping of the heart, hallucinations or loss of consciousness, all of which require immediate medical attention

References:
1. World Health Organization. Information Sheet on Opioid Overdose. Available at: http://www.who.int/substance_abuse/information-sheet/en/.
2. Centers for Disease Control and Prevention. Guideline for prescribing opioids for chronic pain. Available at: www.cdc.gov/drugoverdose/prescribing/guideline.html
3. West Virginia Department of Health and Human Resources


Reference: West Virginia Department of Health and Human Resources

Important Safety Information For Narcan (click to view)
Why is this medication prescribed?

Naloxone nasal spray is used along with emergency medical treatment to reverse the life-threatening effects of a known or suspected opiate (narcotic) overdose. Naloxone nasal spray is in a class of medications called opiate antagonists. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood.

How should this medicine be used?

Naloxone comes as a solution (liquid) to spray into the nose. It is usually given as needed to treat opiate overdoses. Each naloxone nasal spray contains a single dose of naloxone and should be used only once.

You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone nasal spray, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. You and anyone who may need to give the medication should read the instructions that come with the nasal spray. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions.

You should keep the nasal spray available at all times in case you experience an opioid overdose. Be aware of the expiration date on your device and replace the spray when this date passes.

Naloxone nasal spray may not reverse the effects of certain opiates such as buprenorphine (Belbuca, Buprenex, Butrans) and pentazocine (Talwin) and may require additional naloxone doses with a new nasal spray each time.

Symptoms of an opioid overdose include excessive sleepiness, not awakening when spoken to in a loud voice or when the middle of your chest is rubbed firmly, shallow or stopped breathing, or small pupils (black circles in the center of the eyes). If someone sees that you are experiencing these symptoms, he or she should give you your first naloxone dose and then call 911 immediately. After receiving the naloxone nasal spray, a person should stay with you and watch you closely until emergency medical help arrives.

To give the inhaler, follow these steps:

  1. Lay the person on their back to give the medication.
  2. Remove the naloxone nasal spray from the box. Peel back the tab to open the spray.
  3. Do not prime the nasal spray before using it.
  4. Hold the naloxone nasal spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
  5. Gently insert the tip of the nozzle into one nostril, until your fingers on either side of the nozzle are against the bottom of the person's nose. Provide support to the back of the person's neck with your hand to allow the head to tilt back.
  6. Press the plunger firmly to release the medication.
  7. Remove the nasal spray nozzle from the nostril after giving the medication.
  8. Turn the person on their side (recovery position) and call for emergency medical assistance immediately after giving the first naloxone dose.
  9. If the person does not respond by waking up, to voice or touch, or breathing normally or responds and then relapses, give another dose. If needed, give additional doses (repeating steps 2 through 7) every 2 to 3 minutes in alternate nostrils with a new nasal spray each time until emergency medical assistance arrives.
  10. Put the used nasal spray(s) back in the container and out of reach of children until you can safely dispose of it.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before receiving naloxone nasal spray,

  • tell your doctor and pharmacist if you are allergic to naloxone, any other medications, or any of the ingredients in naloxone nasal spray. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Many medications that affect your heart or blood pressure may increase the risk that you will develop serious side effects from using naloxone nasal spray. Be sure to tell your doctor about all the medications you are taking.
  • tell your doctor if you have or have ever had heart disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you receive naloxone nasal spray during pregnancy, your doctor may need to monitor your unborn baby carefully after you receive the medication.
What side effects can this medication cause?

Naloxone nasal spray may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • nasal dryness, nasal swelling, or congestion
  • muscle pain

Some side effects can be serious. If you experience any of these symptoms, get emergency medical treatment:

  • signs of opiate withdrawal such as body aches, diarrhea, fast, pounding, or irregular heartbeat, fever, runny nose, sneezing, sweating, yawning, nausea, vomiting, nervousness, restlessness, irritability, shivering, trembling, stomach cramps, weakness, and the appearance of hair on the skin standing on end
  • seizures
  • loss of consciousness
  • crying more than usual (in babies treated with naloxone nasal spray)
  • stronger than normal reflexes (in babies treated with naloxone nasal spray)

Naloxone nasal spray may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom). Do not freeze the naloxone nasal spray.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What other information should I know?

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Reference: Medline Plus (U.S. National Library of Medicine)

Important safety information for Naloxone injection (click to view)
Why is this medication prescribed?

Naloxone injection and naloxone prefilled auto-injection device (Evzio) are used along with emergency medical treatment to reverse the life-threatening effects of a known or suspected opiate (narcotic) overdose. Naloxone injection is also used after surgery to reverse the effects of opiates given during surgery. Naloxone injection is given to newborns to decrease the effects of opiates received by the pregnant mother prior to delivery. Naloxone injection is in a class of medications called opiate antagonists. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood.

How should this medicine be used?

Naloxone injection comes as a solution (liquid) to be injected intravenously (into a vein), intramuscularly (into a muscle), or subcutaneously (just under the skin). It also comes as a prefilled auto-injection device containing a solution to be injected intramuscularly or subcutaneously. It is usually given as needed to treat opiate overdoses.

You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone injection, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. You and anyone who may need to give the medication should read the instructions that come with the nasal injection. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions.

Naloxone injection may not reverse the effects of certain opiates such as buprenorphine (Belbuca, Buprenex, Butrans) and pentazocine (Talwin) and may require additional naloxone doses.

You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to inject naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to administer the medication. You and anyone who may need to administer the medication should read the instructions that come with the device and practice with the training device provided with the medication. Ask your pharmacist for the instructions or visit the manufacturer's website. In case of emergency, even a person who has not been trained to inject naloxone should still try to inject the medication.

If you have been given an automatic injection device, you should keep the device available at all times in case you experience an opioid overdose. Be aware of the expiration date on your device and replace the device when this date passes. Look at the solution in the device from time to time. If the solution is discolored or contains particles, call your doctor to get a new injection device.

The automatic injection device has an electronic voice system that provides step by step directions for use in an emergency. The person who is injecting naloxone for you can follow these directions, but he or she should know that it is not necessary to wait for the voice system to finish one direction before beginning the next step. Also, at times the voice system may not work and the person may not hear the directions. However, the device will still work and will inject the medication even if the voice system is not working.

Symptoms of an opioid overdose include excessive sleepiness; not awakening when spoken to in a loud voice or when the middle of your chest is rubbed firmly; shallow or stopped breathing; or small pupils (black circles in the center of the eyes). If someone sees that you are experiencing these symptoms, he or she should give you your first dose of naloxone into the muscle or under the skin of your thigh. The medication may be injected through your clothing if necessary in an emergency. After injecting naloxone, the person should call 911 immediately and then stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive a naloxone injection. If your symptoms return, the person should use a new automatic injection device to give you another dose of naloxone. Additional injections may be given every 2-3 minutes if symptoms return before medical help arrives.

Each prefilled automatic injection device should be used only once and then should be discarded. Do not try to replace the red safety guard on the auto-injection device after you remove it, even if you did not inject the medication. Instead, replace the used device in the outer case before discarding. Ask your doctor or pharmacist how to safely dispose of used injection devices.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using naloxone injection,

  • tell your doctor and pharmacist if you are allergic to naloxone injection, any other medications, or any of the ingredients in naloxone injection. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Many medications that affect your heart or blood pressure may increase the risk that you will develop serious side effects of naloxone injection. Be sure to tell your doctor about all the medications you are taking.
  • tell your doctor if you have or have ever had heart, kidney, or liver disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you receive naloxone injection during pregnancy, your doctor may need to monitor your unborn baby carefully after you receive the medication.
What side effects can this medication cause?

Naloxone injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • pain, burning, or redness at the injection site
  • sweating
  • hot flashes or flushing

Some side effects can be serious. If you experience any of these symptoms, get emergency medical treatment:

  • rapid, pounding, or irregular heartbeat
  • seeing things or hearing voices that do not exist (hallucinations)
  • loss of consciousness
  • seizures
  • signs of opiate withdrawal such as body aches, diarrhea, fast heart beat, fever, runny nose, sneezing, sweating, yawning, nausea, vomiting, nervousness, restlessness, irritability, shivering or trembling, stomach cramps, weakness, and the appearance of hair on the skin standing on end
  • crying more than usual (in babies treated with naloxone injection)
  • stronger than normal reflexes (in babies treated with naloxone injection)

Naloxone injection may cause other side effects. Tell your doctor if you have any unusual problems while receiving this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the automatic injection device at room temperature and away from light. If the red safety guard has been removed, safely dispose of the automatic injection device.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What other information should I know?

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Reference: Medline Plus (U.S. National Library of Medicine)