What is the typical initial naloxone dose in EMS and its route?

• A. 2 mg IV
• B. 0.04 mg IM
• C. 0.4 mg IM or IN; may be repeated up to about 2 mg
• D. 1 mg SC

Answer: (C)

Naloxone dosing in EMS is aimed at reversing opioid depression quickly while avoiding excessive withdrawal or agitation, using the smallest effective dose and titrating to response. The typical initial dose is 0.4 mg delivered by intramuscular injection or intranasal administration, and it can be repeated up to about 2 mg total if respiratory status and mental status don’t improve. This approach leverages routes that are fast and easy in the field—IM for quick absorption and IN for rapid administration when IV access isn’t readily available.

Options like 2 mg given IV start too large a dose at once and rely on IV access; 0.04 mg is far too small to reliably reverse symptoms; 1 mg given SC isn’t the standard EMS starting protocol.