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Heroin Toxicity Medication

  • Author: Rania Habal, MD; Chief Editor: Asim Tarabar, MD  more...
Updated: Jul 08, 2016

Narcotic antagonists

Naloxone (Narcan)


In suspected narcotic overdose, small increments (< 0.1 mg) may be used IV until the desired effect is obtained or until 10 mg have been administered with no response. Small increments are used rather than a large bolus injection in order to prevent narcotic withdrawal in the patient who is dependent on opioids. Large bolus injections of naloxone may also unmask adverse effects of co-ingestants (eg, scopolamine, amphetamines, cocaine), resulting in a sympathetic or an anticholinergic crisis. When desired effect is obtained and patient requires continuous infusion, a drip solution is mixed so that two thirds of the originally effective dose is administered qh. To prepare drip, add 40 mg naloxone to 1 L D5W or NS and infuse at 10 mL/h (0.4 mg/h).

Nalmefene (Revex)


Nalmefene prevents or reverses opioid effects (eg, hypotension, respiratory depression, sedation), possibly by displacing opiates from their receptors.


GI decontaminants

Polyethylene glycol (GoLYTELY, Colyte)


Polyethylene glycol is a laxative with strong electrolyte and osmotic effects that has cathartic actions in the GI tract. It is used in whole-bowel irrigation.

Contributor Information and Disclosures

Rania Habal, MD Assistant Professor, Department of Emergency Medicine, New York Medical College

Rania Habal, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Daniel R Ouellette, MD, FCCP Associate Professor of Medicine, Wayne State University School of Medicine; Chair of the Clinical Competency Committee, Pulmonary and Critical Care Fellowship Program, Senior Staff and Attending Physician, Division of Pulmonary and Critical Care Medicine, Henry Ford Health System; Chair, Guideline Oversight Committee, American College of Chest Physicians

Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, Society of Critical Care Medicine, American Thoracic Society

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Laurie Robin Grier, MD Medical Director of MICU, Professor of Medicine, Emergency Medicine, Anesthesiology and Obstetrics/Gynecology, Fellowship Director for Critical Care Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center at Shreveport

Laurie Robin Grier, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society for Parenteral and Enteral Nutrition, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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Heroin-related noncardiogenic pulmonary edema.
Track marks in a heroin intravenous drug user.
Necrotizing fasciitis in a heroin user.
Endocarditis-related septic pulmonary emboli in a heroin user.
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