Comparing Kloxxado® (naloxone HCl) nasal spray 8 mg vs Narcan® (naloxone HCl) Nasal Spray 4 mg and Other Naloxone Offerings

Drug overdose is the leading cause of accidental death in the US, and the majority involve opioids.1 Illicitly manufactured fentanyl, a synthetic opioid which is 50 times stronger than heroin, is a major contributor to this wave of opioid overdose deaths.2 A fentanyl overdose can set in within minutes or even seconds.3,4 More than 150 people die each day from overdoses involving illicitly manufactured synthetic opioids like fentanyl.2

Medicines containing naloxone can safely reverse opioid overdose—even overdoses that involve fentanyl.5 Naloxone does this by attaching to the opioid receptors in the brain to stop the effects of opioids.6 This can help the person start breathing again.6 A naloxone nasal spray, such as Kloxxado® (naloxone HCl) nasal spray 8 mg, can be given to an overdose victim right at the scene by anyone—even if they have no medical training.7,8 Injectable forms of naloxone are available as well.9-11

Forty percent of fatal overdoses occur with someone nearby.12 If you come across someone experiencing an opioid overdose, and you’re carrying naloxone, you may be able to save that person’s life.5 (Click here to learn more about how to recognize an opioid overdose emergency.)

Naloxone is available in many forms, including Kloxxado® and 4 others shown below.7-11

If you’re thinking about carrying naloxone, here is a side-by-side comparison with Kloxxado® so you can decide which one(s) you would feel most comfortable giving in an emergency.

The information below is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations, but rather facts and data collected from various reliable medical sources, including prescribing information and medication guide data. A full list of resources and their attributing links can be found at the end of this article.

Naloxone Medications That Can Be Used to Reverse an Opioid Overdose

Use the tabs below to compare various forms of naloxone.

Kloxxado® (naloxone HCl) Nasal Spray 8 mg7
Delivery Device
Pre-filled nasal spray (non-injectable).
Ready to Use?
Yes
Dosage Form
Nasal spray
Formulation Strength
8 mg naloxone HCl per intranasal dose.
Packaging
Carton contains 2 nasal spray devices.
Initial Dosing
1 spray contains 8 mg of naloxone HCl.
Manufacturer Copay Support
​​Yes
Warnings & Precautions

  • Risk of Recurrent Respiratory and Central Nervous System Depression
  • Risk of Limited Efficacy with Partial Agonists or Mixed Agonist/Antagonists
  • Precipitation of Severe Opioid Withdrawal
Narcan® (naloxone HCl) Nasal Spray 4 mg8
/ Generic Naloxone Nasal Spray
Delivery Device
Pre-filled nasal spray (non-injectable).
Ready to Use?
Yes
Dosage Form
Nasal spray
Formulation Strength
4 mg naloxone HCl per intranasal dose.
Packaging
Carton contains 2 blister packages, each with a single spray device.
Initial Dosing
1 spray contains 4 mg of naloxone HCl.
Manufacturer Copay Support
No
Warnings & Precautions

  • Risk of Recurrent Respiratory and Central Nervous System Depression
  • Risk of Limited Efficacy with Partial Agonists or Mixed Agonist/Antagonists
  • Precipitation of Severe Opioid Withdrawal
Generic Naloxone Prefilled Syringe10 (Naloxone Hydrochloride Injection, USP)
Delivery Device
Pre-filled syringe (injectable).
Ready to Use?
Yes
Dosage Form
Injection
Formulation Strength
2 mg naloxone HCl per device.
(mg / dose is not comparable between nasal and injectable naloxone)
Packaging
Prefilled syringe (packaged individually or in carton of 10).
Initial Dosing
1 injection contains 2 mg naloxone HCl. A partial dose may be given (as low as 0.4 mg).
Manufacturer Copay Support
No
Warnings & Precautions

  • Risk of Recurrent Respiratory and Central Nervous System Depression (listed as “Repeat Administration”)
  • Risk of Limited Efficacy with Partial Agonists or Mixed Agonist/Antagonists
    (listed as “Respiratory Depression Due to Other Drugs”)
  • Precipitation of Severe Opioid Withdrawal (listed as “Drug Dependence”).
  • See the Full Prescribing Information for Naloxone Hydrochloride Injection, USP for the complete list of Warnings and Precautions.
Generic Naloxone Vial11 (Naloxone Hydrochloride Injection, USP)
Delivery Device
Vial (a separate syringe is used to draw up and inject the medicine).
Ready to Use?
No
Dosage Form
Injection
Formulation Strength
0.4 mg naloxone HCl per vial.
(mg / dose is not comparable between nasal and injectable naloxone)
Packaging
1 mL single-dose vial (often packaged in a carton of 25).
Initial Dosing
1 injection contains 0.4 mg of naloxone HCl.
Manufacturer Copay Support
No
Warnings & Precautions

  • Risk of Recurrent Respiratory and Central Nervous System Depression (listed as “Repeat Administration”)
  • Risk of Limited Efficacy with Partial Agonists or Mixed Agonist/Antagonists
    (listed as “Respiratory Depression Due to Other Drugs”)
  • Precipitation of Severe Opioid Withdrawal (listed as “Drug Dependence”).
  • See the Full Prescribing Information for Naloxone Hydrochloride Injection, USP for the complete list of Warnings and Precautions.
ZIMHI® (naloxone HCl Injection) 5 mg / 0.5mL9
Delivery Device
Pre-filled syringe (injectable).
Ready to Use?
Yes
Dosage Form
Injection
Formulation Strength
5 mg naloxone HCl per device.
(mg / dose is not comparable between nasal and injectable naloxone)
Packaging
Carton contains 2 cases, each with a single pre-filled injection device.
Initial Dosing
1 injection contains 5 mg of naloxone HCI.
Manufacturer Copay Support
Yes
Warnings & Precautions

  • Risk of Recurrent Respiratory and Central Nervous System Depression
  • Risk of Limited Efficacy with Partial Agonists or Mixed Agonist/Antagonists
  • Precipitation of Severe Opioid Withdrawal
  • Risk of Accidental Needlestick Injury

A Key Difference Between Kloxxado® and Narcan®

Kloxxado® contains 8 mg of naloxone in a single dose compared to the 4 mg of naloxone in a single dose of Narcan®.7,8 This higher dose could be very important in an emergency overdose situation.13 According to research published in 2021, about 78% of opioid overdose reversals involved at least 8 mg of naloxone and about 30% of overdoses involved at least 12 mg of naloxone.13 This may be why the majority of participants in the study who had given naloxone to another person said they would prefer the higher dose, if available.13 The majority also said they would have more confidence in an 8 mg naloxone spray than in a 4 mg naloxone spray.13

Kloxxado® Is Easy to Use and Carry

Kloxxado® is a nasal spray, so it’s a simple way to prevent an opioid overdose from becoming fatal.7 Click here for a downloadable quick instructions sheet. If you or a friend or loved one could be at risk for an accidental opioid overdose, keep Kloxxado® in your pocket, backpack or purse and be ready to take action.7 (Store Kloxxado® at 20°C to 25°C [68°F to 77°F], with temperature excursions permitted to 40°C [104°F] and to 5°C [41°F].7 Do not store Kloxxado® at or above 40°C [104°F].7 Do not freeze Kloxxado®.7 Protect Kloxxado® from light and keep out of the reach of children.7) Kloxxado® nasal spray is not a substitute for emergency medical care.7

How to Learn More About Kloxxado®

To learn more about Kloxxado®, ask your doctor or pharmacist or visit Kloxxado.com.

Kloxxado® is a registered trademark of Hikma Specialty USA Inc.
All other registered trademarks are the property of their respective owners.

Please see the Full Prescribing Information and Medication Guide for Kloxxado® for complete product details.

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

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References

  1. Addressing the Opioid Crisis. National Safety Council website. Available at: Opioids Home – National Safety Council (nsc.org). Accessed April 26, 2023.
  2. Fentanyl Facts. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/stopoverdose/fentanyl/index.html. Accessed March 21, 2023.
  3. Somerville NJ et al. Characteristics of Fentanyl Overdose—Massachusetts, 2014-2016. MMWR. 2017;66(14):382-386.
  4. US Surgeon General’s Report on Alcohol, Drugs, and Health. US Department of Health and Human Services. Accessed March 26, 2021. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.
  5. Access to Naloxone Can Save a Life During an Opioid Overdose. US Food and Drug Administration website. Available at: https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose. Accessed March 17, 2023.
  6. Naloxone DrugFacts. National Institutes of Health/National Institute on Drug Abuse website. Available at: https://nida.nih.gov/publications/drugfacts/naloxone. Accessed April 4, 2023.
  7. Kloxxado® (naloxone HCl) nasal spray 8 mg [prescribing information]. Columbus, OH: Hikma Pharmaceuticals USA Inc.; 2021.
  8. Narcan® (naloxone HCl) nasal spray 4 mg [prescribing information]. Plymouth Meeting, PA: Emergent Devices Inc.; 2021.
  9. ZIMHI® (naloxone HCl Injection) 5mg/0.5mL [prescribing information]. San Diego, CA: Adamis Pharmaceuticals Corporation; 2021.
  10. Naloxone Hydrochloride Injection, USP [prescribing information]. Berkeley Heights, NJ: Hikma Pharmaceuticals USA Inc; 2022.
  11. Naloxone Hydrochloride Injection, USP [prescribing information]. Eatontown, NJ: Hikma Pharmaceuticals USA Inc; 2019.
  12. Morbidity and Mortality Weekly Report (MMWR) Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants–24 States and the District of Columbia, January-June 2019. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6935a1.htm. Accessed April 2, 2023
  13. Abdelal R, Banerjee A, Carlberg-Racich S, Darwaza N, Ito D, Shoaff J, Epstein J. Real-World Study of Multiple Naloxone Administration for Opioid Overdose Reversal Among Bystanders. JMCP. 2021;27(10-a):S54.