As PCPs are we allowed diluting Narcan 0.4mg/ml 1:9 with NS when giving it IV route? (0.04mg/10ml) titrate to effect.
Yes. As listed under Clinical Considerations within the Opioid Toxicity Medical Directive, combative behavior should be anticipated following naloxone administration and paramedics should protect themselves accordingly, including consideration for gradual titration (if given IV) to desired clinical effect: respiratory rate ‰¥ 10, adequate airway and ventilation, not full alertness.
Administration of the full 0.4mg IV dose, at once, may also be given. However, remember to take all possible safety precautions, should the patient be combative when quickly reversed.
Please note that the other routes of administration (SC/IM/IN) cannot be titrated and must be given as 0.8mg/dose due to the pharmacologic properties of the drug and route, as described in the 22-Dec-2017 Ask MAC.