New naloxone (Kloxxado) 8 mg nasal spray will raise questions about which dose to provide patients taking opioids.
We're used to ensuring patients get a discharge Rx for naloxone 4 mg intranasal or 0.4 mg IM.
Kloxxado is touted as having "twice as much naloxone per spray" as Narcan nasal spray. And people are hearing that higher doses may be needed, since overdoses from "ultra-potent" fentanyl-like compounds are rising.
But there's no good evidence that Kloxxado is more effective...works quicker...or lasts longer. Point out that all naloxone forms can be repeated every 2 to 3 minutes if needed.
Plus there are concerns that higher naloxone doses may lead to more severe withdrawal symptoms.
Focus on increasing access to naloxone...rather than which product to use. Tailor the choice based on patient and payer preference.
In general, go with a ready-to-use nasal spray for ease of administration. Narcan or Kloxxado costs about $130/2 doses...but expect more payers to cover Narcan for now.
Or consider an intranasal or IM naloxone kit...pharmacies may be able to prepare these, using syringes, vials, etc. These kits start at about $30...but require some patient assembly.
If needed, refer to local programs that offer naloxone at no charge.
Continue to identify patients getting a discharge opioid or med for opioid use disorder (buprenorphine, etc). Ensure they receive a discharge naloxone Rx...and provide education.
Bring up naloxone as a routine and automatic part of educating about opioids, just as you'd talk about constipation or sedation.
Use clear language with patients that avoids stigma. For example, say, "Naloxone's like a seat belt, it's there to keep you safe."
Advise keeping at least 2 doses on hand.
Instruct patients to teach family and friends about when to give naloxone...how to use it...and to call 911 and seek follow-up.
Stay tuned for another new naloxone...Zimhi 5 mg injectable.
Use our FAQ, Naloxone for Opioid Overdose, for product comparisons and video links to walk patients through administration.
- https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html (10-27-21)
- https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf (10-27-21)
- J Addict Med. 2020 Mar/Apr;14(2S Suppl 1):1-91
- J Med Toxicol. 2020 Jan;16(1):41-48
- https://www.fda.gov/drugs/drug-safety-and-availability/new-recommendations-naloxone (10-27-21)
- Medication pricing by Elsevier, accessed Oct 2021