DHS is looking to set policy for use of the drug naloxone to reverse accidental opioid exposure (signs: walking drunk, vomiting, pinpoint pupils, severe sedation, slowed respiratory rate, slowed heart rate, coma, respiratory arrest) in their working canines. Drug enforcement canines occasionally inhale or contact narcotics and exhibit signs. Naloxone is used by veterinarians in dogs as an extra-label administration, but it is given intravenously (IV) or intramuscularly (IM). What is the group’s experience or reference information regarding the use of the intranasal (IN) form of naloxone in dogs?
From an expert in veterinary anesthesia, analgesia, and pain management we consulted:
I believe there is no data to support the use of intranasal naloxone in dogs. We all know that intranasal medications / vaccines are variably difficult to administer to dogs based on their demeanor. However naloxone is a highly lipophilic drug which likely crosses the nasal mucosa easily to the vascular system. If a law enforcement dog inhales enough of an opioid to be sedated, it likely will allow intranasal administration.
The normal starting dose of naloxone for opioid reversal starts at 0.04 mg/kg IV / intranasal and is reduced as needed. If we consider that most of our dogs law enforcement dogs are 40 kg or less, we can do the same thing for them. (NOTE: 1 spray delivered by IN administration delivers 4 mg of naloxone HCl. Dosage recommendation of 0.04 mg/kg for a 40 kg canine = 1.6 mg.) I would give a dog half to whole dose of the intranasal formulation. I think it is important for all handlers, care providers and associated law enforcement recognize that opioid induce respiratory depression is a human and non-human primate problem. Large doses of opioids in dogs will induce sedation but is unlikely to induce respiratory depression. They may become bradycardic and bradypneic, but their minute ventilation should remain normal due to greater tidal volume.
James S. Gaynor, DVM, MS
Diplomate, American College of Veterinary Anesthesia & Analgesia
Diplomate, American Academy of Pain Management
Certified Veterinary Acupuncturist-IVAS
Certified Veterinary Pain Practitioner- IVAPM