Related Guidance:

Poisoning and toxicity: resources to support answering questions (SPS)

Overdose Awareness & Prevention

  • Naloxone is for everyone.
    • Help prevent opioid overdoses in Somerset by accessing free training and naloxone kits.
  • Carry Naloxone.
    • Download the Carry Naloxone app to find locations, opening times and directions to naloxone suppliers in Somerset, and access useful information to recognise and respond to an overdose.
Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Anaesthetics, LocalTetracaine as Ametop®4% gel: £1.08 (1.5g)First line.
Lidocaine5% ointment: £10.50 (15g)Second line.
Lidocaine with prilocaine as Emla®2.5% and 2.5% cream: £2.25 (5g), £12.30 (30g)Third line.

as Ralvo®
700mg medicated plaster: £61.54 (30)Indicated for the symptomatic relief of neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia, PHN) in adults.

Max use 12 hours per day re-evaluate need every 2 weeks.

Long term use not recommended.

Trusts initiating prescribing for acute fracture pain should discharge patient with full course - GPs should NOT continue use for off-license indications.

Not recommended for other indications.
Opioid receptor antagonistNaloxone400mcg/ml solution for injection ampoule: £41.23 (10)

Acute opioid overdose–high-dose regimen [when rapid titration with naloxone is necessary to reverse potentially life-threatening effects]

Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients), then review diagnosis; further doses may be required if respiratory function deteriorates following initial response, intravenous administration has more rapid onset of action, doses may be given by intramuscular route but only if intravenous route is not feasible.
2mg/2ml solution for injection pre-filled syringe: £18.00 (1)