Naltrexone

If you are not getting benefit from methadone and buprenorphine, you can switch to another drug therapy known as Naltrexone. Naltrexone is a long-acting opioid antagonist. It helps in the reduction of opioid effects. It is available in the form of extended-release injections and oral formulation.


Treatment Goals and Patient Selection


The use of naltrexone recommended to the patients who:

In addition, the goals of treatment with naltrexone include

· For prevention of relapse in patients who have left opioids

· For blocking the effects of illicit opioids

· For reduction of cravings

· For the promotion of patient engagement in psychosocial intervention

I have seen a patient in the United States who dealt with his condition by using naltrexone. He is now enjoying the blessings of life. It is more effective in patients with multiple substance abuse. (Tiihonen et al., 2012)


Oral naltrexone


This way of administration is best suitable for the patient:

· Are highly motivated

· Have strict supervision


The reason behind this caution is that this drug can lead to non-adherence and the potential of overdose upon relapse. A report shows that oral naltrexone has a positive effect on patients as compared to placebo. (Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, 2011) (Y Adi, A Juarez-Garcia, D Wang, S Jowett, E Frew, E Day, S Bayliss, T Roberts, 2007)


Extended-release injectable naltrexone


This type of therapy is recommended for patients who

· Have contraindication with methadone or buprenorphine

· Live in a drug-free environment

· Are highly motivated

· Do not want agonist therapy


Precautions


Opioid overdose

The misjudgment of dose at the time of relapse can lead to overdose. (Strang et al., 2003)


Course of Treatment


Initial dose

Detoxification of opioids from the blood is essential before starting naltrexone. Detoxifying the body is necessary; otherwise, it may lead to severe withdrawal symptoms.


According to rule, a patient should be withdrawn from the opioids:

For short-acting; six days before use

For long-acting; 7-10 days before use


Do you know about the naloxone challenge?


If there is any uncertainty about the use of opioids by the patient, the naloxone challenge comes into the scene. It is a short-acting injectable opioid antagonist. A small dose of this drug is administered to the patient and his signs and symptoms are observed. If naloxone is not available, a small dose of oral naltrexone is used as a substitute.


Maintenance dose


Oral; 50mg OD or 150mg followed by 100mg twice a week

Extended-release injectable naltrexone; 390mg per injection, every month, intramuscularly


Adverse Effects


Injection site reaction; it can be reduced by using longer needles. (Preston et al., 1998)

· Insomnia

· Lack of energy

· Cold-symptoms

· Joint and muscle pain

· Psychosocial Treatment

Medical recommend psychological treatment along with naltrexone therapy. Both of these treatments stand with each other.


Monitoring the Treatment


Before starting the therapy, we monitor the patient for any residual opioid in his/her blood. The patient then kept under keen observation, once the treatment starts. Then we check for stability observation according to some scales.


During this therapy, assessment of ‘Prescription Drug Monitoring Programs’ is important. Medical therapists also suggest the objective measurement for best therapy outcomes.


Then we do urine analysis and blood analysis to check the presence of benzodiazepines, marihuana, amphetamines, and many more.


Length of Treatment


The length of treatment depends on the patient and its circumstances.


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