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Naloxone titration — DipIMC MCQ

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ModeratePre-hospital PharmacologyNaloxone titrationDipIMC

A 63-year-old woman with opioid toxicity improves after naloxone but becomes agitated with severe cancer pain and early withdrawal. Respirations are now 18/min and saturations are 96%. What is the most appropriate immediate action?

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Correct answer: E — Titrate further naloxone to maintain adequate ventilation and monitor for recurrence

Naloxone should be titrated to restore adequate ventilation, not to abolish opioid effect completely in opioid-dependent or palliative patients. Re-sedation can occur because naloxone duration may be shorter than the opioid involved. Flumazenil does not prolong naloxone and may be dangerous in mixed overdose. The pearl is that the endpoint is breathing, not punishment through withdrawal.

Reference: JRCALC Guidelines 2025; TOXBASE principles