Think of Kloxxado as a Higher-Dose Naloxone Nasal Spray

You'll see Kloxxado, a new naloxone nasal spray to help reverse an opioid overdose.

Think of Kloxxado as having twice as much naloxone per dose as Narcan nasal spray. Kloxxado contains 8 mg naloxone per spray...Narcan has 4 mg per spray.

People are hearing that higher naloxone doses may be needed, since overdoses from "ultra-potent" fentanyl-like compounds are on the rise.

But any rescue naloxone product can help save a life.

And there's no good evidence that Kloxxado is more effective...works quicker...or lasts longer.

There are also concerns that higher naloxone doses may lead to more severe withdrawal symptoms...such as agitation or combativeness.

If you dispense Kloxxado, expect to see the same sig as for Narcan. One spray is administered into one nostril during an overdose...with a repeat dose every 2 to 3 minutes if needed, alternating nostrils.

Watch for payer messaging. Kloxxado or Narcan costs about $130/2 doses...and both are ready-to-use devices. But more payers are covering Narcan for now.

If cost or coverage is a barrier, work with your pharmacist to find alternatives. Your pharmacy may be able to prepare an intranasal or IM naloxone kit...using syringes, vials, etc. These start at about $30...but require some patient assembly.

Or refer people to local programs that offer naloxone at no charge.

Continue to look for opportunities to improve naloxone access.

For instance, notify your pharmacist when patients are picking up opioids (oxycodone, etc) or meds for opioid use disorder (buprenorphine, etc). Labeling for these meds recommends discussing naloxone with each Rx.

Ensure patients and caregivers getting any form of naloxone receive pharmacist counseling on how to use it, follow-up care, etc.

Find more advice on naloxone billing, preparing kits, and storage in our FAQ, Naloxone for Opioid Overdose.

Key References

  • www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html (9-24-21)
  • https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf (9-24-21)
  • J Addict Med 2020;14(2S Suppl 1):1-91
  • J Med Toxicol 2020;16(1):41-8
  • www.fda.gov/drugs/drug-safety-and-availability/new-recommendations-naloxone (9-24-21)
  • Medication pricing by Elsevier, accessed Sep 2021
Pharmacy Technician's Letter. October 2021, No. 371004



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