Do you have questions about NARCAN™ Nasal Spray?

Find answers to the most frequently asked questions about NARCAN™ Nasal Spray.

What is NARCAN™ Nasal Spray?

NARCAN™ Nasal Spray is used to treat someone who has overdosed on opioids. NARCAN™ Nasal Spray can be used by anyone to reverse the effects of the overdose until medical help arrives.

When should NARCAN™ Nasal Spray be used?

Use NARCAN™ Nasal Spray right away if you think there are signs of an opioid overdose emergency.

Signs of an opioid overdose may include:

  • Slow or weak breathing
  • Gradual increase in breathing followed by a decrease in breathing and airflow
  • Trouble breathing or not breathing
  • Deep snoring or gurgling noises
  • Dizziness, confusion, drowsiness including extreme drowsiness
  • Passing out
  • Collapse and coma
  • Unable to be woken up by touch, shaking of shoulders or shouting
  • Slow or no heartbeat
  • Cold, pale, clammy skin
  • Very small pupils, like a pinpoint

Get emergency medical help right away in any case of known or suspected overdose.

NARCAN™ Nasal Spray is not a substitute for emergency medical care. Administer in accordance with the Instructions for Use.

Who should not use NARCAN™ Nasal Spray?

Do not use NARCAN™ Nasal Spray if you are sure that the patient is allergic to naloxone hydrochloride or to any of the ingredients in NARCAN™ Nasal Spray.

Use in infants with extreme caution. Please see Patient information, Product Monograph.

How should I use NARCAN™ Nasal Spray?

Read the Patient Medication Information here for detailed information about how to administer NARCAN™ Nasal Spray.

Important Points:

  • NARCAN™ Nasal Spray is for use in the nose only.
  • Do not test the NARCAN™ Nasal Spray device. Keep it in the package until it is needed.
  • Each NARCAN™ Nasal Spray device contains only 1 dose and cannot be reused.
  • NARCAN™ Nasal Spray is not a substitute for emergency medical care. Always call 911 before administering NARCAN™ Nasal Spray.

Does NARCAN™ Nasal Spray only work in the nose?

Yes, NARCAN™ Nasal Spray is for intranasal (in the nose/nostril) use only.

Before I use NARCAN™ Nasal Spray, do I need training? Do I need to assemble NARCAN™ Nasal Spray or measure the medicine?

There is no special training, measuring or assembly required to use NARCAN™ Nasal Spray. NARCAN™ Nasal Spray comes as a ready-to-use device that contains a single, pre-filled, pre-measured dose of naloxone. NARCAN™ Nasal Spray should be used in accordance with the “How to administer NARCAN™ Nasal Spray” section contained in Patient Medical Information. The caregiver should familiarize themselves with these instructions in order to be sure to administer NARCAN™ Nasal Spray properly.

Can I give myself NARCAN™ Nasal Spray?

No, treatment of suspected opioid overdose must be performed by someone other than the affected person.

How does NARCAN™ Nasal Spray work?

NARCAN™ Nasal Spray is administered in the nostril and does not require evidence of breathing through the nose during administration.

Opioid drugs work by acting on specific receptors found in the brain and in the nervous system. Taking too many opioids can lead to an overdose and that can stop someone from breathing.3

Naloxone, the active ingredient in NARCAN™ Nasal Spray, stops the opioids from being attached to the receptors and this reverses the effects and symptoms of the overdose.3

Get emergency medical help right away in any case of known or suspected overdose emergency. NARCAN™ Nasal Spray is not a substitute for emergency medical care. Administer in accordance with the instructions provided in the Patient Medical Information.

Each device is a single dose. If an additional dose is needed, you must use another device.

Can I reuse NARCAN™ Nasal Spray?

No, you cannot reuse NARCAN™ Nasal Spray. Each device is single-use, single-dose only. It is intended to be sprayed once, in a nostril, and then discarded.

Will one dose of NARCAN™ work to reverse an overdose, or will a second dose be needed?

A second dose of NARCAN™ Nasal Spray may be necessary. One dose of naloxone may not be enough to reverse the effects of an opioid overdose that involves strong opioids. Or, sometimes, the naloxone dose can wear off before the opioids—necessitating another dose.

Emergency medical services (EMS) will have been called immediately and will hopefully arrive before a second dose is needed. But if help hasn’t arrived, bystanders can administer additional doses of NARCAN™ Nasal Spray every 2 to 3 minutes in alternating nostrils if the patient doesn’t respond, responds insufficiently or relapses back into respiratory depression.

Get emergency medical help right away in any cases of known or suspected overdose emergency. NARCAN™ Nasal Spray is not a substitute for emergency medical care. Administer in accordance with the Instructions for Use.

Warnings you should know about:

Non-opioid overdoses:

NARCAN™ Nasal Spray does not reduce the effects of an overdose caused by other drugs such as:

  • barbiturates
  • benzodiazepines
  • psychostimulants (for example: cocaine, amphetamines or methylphenidate)
  • alcohol
  • anesthetics
  • sedatives

Giving NARCAN™ Nasal Spray to a person because of a non-opioid overdose is unlikely to cause more harm.

Return of Opioid Overdose Symptoms:

It may be possible that the signs of an opioid overdose return after a dose of NARCAN™ Nasal Spray has been given. For example, a patient who responded to the first dose may experience a return of the signs of an overdose.
You should:

  • monitor the patient.
  • give repeated doses of NARCAN™ Nasal Spray to the patient if needed and available.
  • lie the patient on their side to help them have a clear airway.
  • perform artificial respiration or cardiac massage, only if needed and if you know how.
  • wait for emergency medical help to arrive.

Acute Opioid Withdrawal Syndrome:

  • NARCAN™ Nasal Spray should be given with caution to a patient who may be or who is addicted to opioids.
  • After receiving NARCAN™ Nasal Spray, the patient may go into Acute Opioid Withdrawal Syndrome. Symptoms include:
    • shaking or having seizures
      • move away any sharp and dangerous objects to prevent injury
      • do not try to hold the patient down
    • vomiting
      • place the patient on their side to prevent choking if they vomit
    • pain
    • fever
    • restlessness
    • irritability
    • aggressive behavior
    • sweating
    • yawning
    • weakness
    • shivering
    • trembling
    • increased blood pressure
  • Acute Opioid Withdrawal Syndrome can be life-threatening for a newborn. Symptoms in newborns also include:
    • excessive crying
    • twitching and hyperactive reflexes

Heart problems:
Naloxone is the active ingredient in NARCAN™ Nasal Spray. After using naloxone some patients had:

  • a heart attack
  • an increased heart rate
  • an irregular heartbeat

These side effects were rare. It is not known if the reactions were caused by naloxone or by the overdose.

Recent surgery:
The following occurred when some patients who had a recent surgery received naloxone:

  • high and low blood pressure
  • increased heart rate
  • rapid irregular heartbeat
  • a build-up of fluid in the lungs
  • in rare cases, cardiac arrest

These side effects were rare. It is not known if the reactions were caused by naloxone or by the overdose.

Nasal problems:
It is not known if having any nasal problems will impact how NARCAN™ Nasal Spray works. Examples of nasal problems include a blocked or runny nose or nasal polyps. If NARCAN™ Nasal Spray is the only medication available to treat an opioid overdose, it should always be used.

Pregnant Women:
NARCAN™ Nasal Spray should only be used in pregnant women when clearly needed.

Nursing Women:
Use in nursing women has not been established.

For more information on NARCAN™ Nasal Spray, contact ADAPT Medical Information at 1-844-898-0657.

How do you administer NARCAN™ Nasal Spray?

Key steps to administering NARCAN™ Nasal Spray can be found here.

And, if you haven’t already done so, get emergency help right away. Continue to watch the patient.

If help hasn't arrived yet and the patient is not responding after 2 to 3 minutes, or responds and then relapses back into respiratory depression, give another dose. Make sure to use another device, as each device contains only one dose.

Get emergency medical help right away in any case of known or suspected overdose emergency. NARCAN™ Nasal Spray is not a substitute for emergency medical care. Administer in accordance with the Instructions for Use.

These steps are not comprehensive. See the Instructions for Use for more information. Administer in accordance with the Instructions for Use.

Is NARCAN™ Nasal Spray addictive?

No, naloxone has no potential for abuse or overdose. It does not work in the absence of opioids.3

What are the possible side effects from using NARCAN™ Nasal Spray?

Adverse events may include:3

  • swelling in the nose,
  • dryness in the nose,
  • congested nose,
  • runny nose;
  • yawning, nervousness,
  • pain,
  • aggressive behaviors, irritability, restlessness, agitation;
  • increased blood pressure;
  • increased heart rate;
  • nausea, vomiting, diarrhea, abdominal cramps;
  • shivering, chills, tremors, trembling;
  • fever, sweating, weakness,
  • seizures, shaking, muscle spasms;
  • dizziness, headache

These are not all of the possible side effects of NARCAN™ Nasal Spray. For more information on NARCAN™ Nasal Spray, contact ADAPT Medical Information at 1-844-898-0657.

View the full Product Monograph

What are the ingredients in NARCAN™ Nasal Spray?

Active ingredient: naloxone hydrochloride

Inactive ingredients: benzalkonium chloride, disodium ethylenediaminetetraacetate, sodium chloride, hydrochloric acid and purified water.

NARCAN™ Nasal Spray is not made with natural rubber latex.

How should I store NARCAN™ Nasal Spray?

Keep NARCAN™ Nasal Spray in its box until ready to use.

  • Store between 15°C to 25°C.
    • NARCAN™ Nasal Spray may be stored for short periods up to 40°C.
    • Do not store NARCAN™ Nasal Spray in the car on hot summer days.
    • Do not freeze or leave NARCAN™ Nasal Spray in a car during the winter.
    • NARCAN™ Nasal Spray may not be as effective if it is not stored properly. If NARCAN™ Nasal Spray gets frozen or is stored at 40°C for long periods of time, you should replace it. Only discard the NARCAN™ Nasal Spray once you have a replacement for it. If you don’t replace NARCAN™ Nasal Spray before it is needed, it is better to use it, even if it hasn’t been stored properly.
  • Store in a dark place and protect from light.
  • Replace NARCAN™ Nasal Spray before the expiration date on the box.
    • If only expired NARCAN™ Nasal Spray, it should be used in an overdose situation.
  • Keep out of reach and sight of children.

Where can I buy NARCAN™ Nasal Spray?

Organizations wishing to order NARCAN™ Nasal Spray:

  • Place your order by telephone at 1-877-870-2726 from 8 am until 9 pm Eastern Standard Time or contact ADAPT Customer Support by e-mail at adaptcanada@customer-support.ca

View Terms and Conditions

Individuals, families, and caregivers wishing to order NARCAN™ Nasal Spray:

Talk to your pharmacist. In December 2016, the National Association of Pharmacy Regulatory Authorities (NAPRA) recommended that Naloxone Nasal Spray, when indicated for emergency use for opioid overdose, be made available as a Schedule II drug. This means that any patient or patient’s agent can obtain NARCAN™ Nasal Spray directly from a community pharmacist without a prescription. Call your local pharmacy beforehand to confirm that they have NARCAN™ Nasal Spray in-stock; if the pharmacy does not stock NARCAN™ Nasal Spray they can likely order it on your behalf. In some provinces*, NARCAN™ Nasal Spray has made an unscheduled drug, meaning that it can be purchased outside of pharmacies.

*Check with your local pharmacist about how to access NARCAN™ Nasal Spray in your province

Can NARCAN™ Nasal Spray be used on a child?

NARCAN™ (naloxone) could trigger an acute opioid withdrawal syndrome in the dependent neonate which may be life-threatening if not recognized and properly treated. Emergency medical assistance (i.e., calling 911) should be requested immediately, before administering naloxone in a neonate.

Are there any other safety considerations concerning the use of NARCAN™ Nasal Spray?

Click here to view the Important Safety Information

Serious Warnings and Precautions

  • Before administering NARCAN™ Nasal Spray, call 911 for emergency medical help. Do this immediately if you suspect or are aware of an opioid overdose.
  • Make sure to watch the person who received NARCAN™ Nasal Spray. You may need to give additional doses of NARCAN™ Nasal Spray until emergency medical help arrives.
  • You may need to help the person who received NARCAN™ Nasal Spray. The patient may have a reaction such as becoming aggressive, shaking and/or vomiting. You will need to pay special attention when giving NARCAN™ Nasal Spray to a newborn who is less than four weeks old or a pregnant woman. Some of these reactions can be life-threatening for a newborn or a fetus.

Indications and Clinical Use

NARCAN™ Nasal Spray is a pure opioid antagonist indicated for emergency use outside of a hospital to reverse known or suspected opioid overdose, as manifested by respiratory and/or severe central nervous system depression.

NARCAN™ Nasal Spray can be administered by a bystander (non-healthcare professional) before emergency medical assistance becomes available, but it is not intended to be a substitute for professional medical care. Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before administering naloxone.

Contraindications

  • Patients who are hypersensitive to this drug or to any ingredient in the formulation or component of the container.

Most Serious Warnings & Precautions

  • Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before using naloxone.
  • Individuals with a satisfactory response to an initial dose of naloxone should be kept under continued surveillance.
  • Caregivers administering naloxone should be prepared to act in response to or assist the patient in cases of potential adverse reactions such as aggressive reactions, convulsions and vomiting. Special attention is warranted if naloxone is administered to a neonate or a pregnant woman.

Other Relevant Warnings and Precautions

  • In opioid dependent people, naloxone may trigger an acute opioid withdrawal syndrome
  • Rebound opioid toxicity, including respiratory depression, following the temporary reversal of the opioid overdose
  • Not effective against respiratory depression due to non-opioid drugs
  • Rare cases of cardiac arrest, tachycardia and ventricular fibrillation
  • Post-operative consideration: instances of hypotension, hypertension, ventricular tachycardia and fibrillation, dyspnea, pulmonary edema and rare cases of cardiac arrest have been reported. Death, coma, and encephalopathy have been reported as sequelae of these events
  • Rare cases of convulsions or seizures
  • Irritability and aggressive behaviour
  • Gastrointestinal reactions including diarrhea, nausea, vomiting and abdominal cramps
  • Use in nursing women has not been established

For More Information:

Please consult the product monograph at http://narcannasalspray.ca/pdf/NARCAN-Product-Monograph-ca-en.pdf for important information relating to contraindications, adverse reactions, drug interactions, patient selection, and dosing information which have not been discussed in this piece.

The product monograph is also available by calling 1-844-898-0657.

Please see full Product Information including the Patient Information for NARCAN™ Nasal Spray.

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References

1 World Health Organization. “Management of Substance Abuse: Information sheet on opioid overdose.” November 2014. http://www.who.int/substance_abuse/information-sheet/en/ Accessed March 1, 2017.

2 Ontario College of Pharmacists. “Dispensing or Selling Naloxone: Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug.” February 9, 2017. http://www.ocpinfo.com/library/practice-related/download/Naloxone.pdf Accessed March 1, 2017.

3 NARCAN™ Nasal Spray Product Monograph. Adapt Pharma Operations Limited, March 24, 2017.

4 Howlett, K et al. “How Canada got addicted to fentanyl.” Globe and Mail, January 5, 2017. http://www.theglobeandmail.com/news/investigations/a-killer-high-how-canada-got-addicted-tofentanyl/article29570025/ Accessed January 10, 2017.

5 National Institutes of Health, PubChem Open Chemistry Database, Carfentanil, Available at: https://pubchem.ncbi.nlm.nih.gov/compound/carfentanil#section=Top Accessed on January 20, 2017.

6 Harm Reduction Coalition. “Overdose FAQs.” http://harmreduction.org/issues/overdose-prevention/overview/overdose-faqs/ Accessed January 11, 2017.

7 Government of Canada. “Opioids.” http://healthycanadians.gc.ca/healthy-living-vie-saine/substance-abus…icomanie/prescription-abuse-abus-ordonnance/opiods-opiodes-eng.php#a2 Accessed Jan 9, 2017.

8 Government of Canada. “Opioids.” Available at: https://www.canada.ca/en/health-canada/services/substance-abuse/prescription-drug-abuse/opioids.html Accessed January 25, 2017.

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© 2017 ADAPT Pharma Canada Ltd. NARCAN is a trademark licensed to ADAPT Pharma Operations Limited.

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