In suspected opioid overdose, regarding naloxone dosing, which statement is true?

• A. Only a single dose should ever be given
• B. Repeated doses may be necessary if there is no response
• C. Naloxone is contraindicated in all opioid cases
• D. Naloxone should be followed by long‑acting opioids to prevent rebound symptoms

Answer: (B)

Naloxone reverses opioid-induced respiratory depression by competing at mu receptors, producing rapid improvement in breathing. But its effect is short—often shorter than the duration of some opioids. When the opioid stays active longer than the naloxone, symptoms can return, a situation known as renarcotization. Because of this, repeated doses of naloxone are often necessary to keep the patient breathing adequately until the opioid is cleared or a continuous infusion is used. The aim is to titrate to respiratory status and maintain ventilation, not to force a full awakening at the expense of safety. In real practice, if a long-acting opioid is involved, you may need ongoing naloxone support rather than additional opioids, which would worsen the overdose.