Rumack and Temple in their thoughtful analysis of Lomotil poisoning1 note that narcotic antagonists should be used "as soon as adequate indications exist." From our experience with Lomotil toxicity in the last three years at Children's Hospital Medical Center and with other drugs producing narcotic like effects,2.3 we would like briefly to comment on the indications for the use of the narcotic antagonist, naloxone (Narcan) hydrochloride. Four prominent signs of naloxone efficacy exist: (1) dilatation of constricted pupils; (2) increase in depth and rate of respiratory effort; (3) reversal of hypotension; and (4) correction of an obtunded or comatose state.4