Are there absolute contraindications to naloxone in suspected overdose?

• A. There are no absolute contraindications in overdose; caution with opioid-dependent patients due to withdrawal.
• B. Naloxone should be avoided in patients with known allergy to naloxone.
• C. Naloxone is contraindicated during pregnancy.
• D. It should not be used if the patient has ceased breathing.

Answer: (A)

In suspected opioid overdose, the priority is to reverse life-threatening respiratory depression with naloxone. There are no absolute contraindications to giving naloxone in this emergency setting; the benefits of reversing the overdose far outweigh potential downsides. The main caveat is that naloxone can precipitate withdrawal in people who are opioid-dependent, which can cause agitation, nausea, sweating, tachycardia, or hypertension. This risk leads clinicians to titrate the dose carefully to restore breathing while minimizing withdrawal symptoms. Other scenarios such as pregnancy or apnea do not remove the appropriateness of naloxone in an overdose context, though the clinician always weighs benefits and monitors for adverse effects.