Antidote: naloxone

Naloxone is an opioid antagonist used to reverse the effects of the opioid in patients with hypoventilation.

Higher doses of naloxone may be required to reverse the effects of buprenorphine than for other opioid poisonings. Support of airway and breathing is the priority to prevent hypoxia while waiting for naloxone to take effect.

As naloxone has a shorter duration of effect than buprenorphine, patients who have injected the sublingual coformulation of buprenorphine and naloxone may still require management with naloxone for buprenorphine toxicity at a later time.

A bolus dose of naloxone should be used initially; repeat bolus doses titrated to clinical effect may be required. A naloxone infusion may be indicated for patients in whom toxicity recurs after initial response to a naloxone bolus.

In patients with opioid-dependence, titrate naloxone to avoid acute withdrawal. Sudden or complete reversal of buprenorphine toxicity can cause complications, including agitation and behavioural disturbance and, rarely, cardiovascular effects.