Pharm
Naltrexone
search
Naltrexone
, Trexan, Revia, Vivitrol
Indications
Substance Dependence (especially with history of relapse)
Alcoholism
Opioid Dependence
Must be used with an aftercare program
Low dose Naltrexone (0.5 mg to 4.5 mg/day) has also been proprosed for various conditions including
Chronic Pain
No rigorous evidence of benefit at these low doses and for these varied conditions, but unlikely to cause harm
Postulated to up-regulate
Opioid
receptors, increas endorphin production and act as
Analgesic
and antiinflammatory
May cause
Opioid Withdrawal
if used soon after last use of
Opioid
s
(2020) Presc Lett 27(4): 22
Toljan (2018) Med Sci 6(4): 82 [PubMed]
Contraindications
Long-term
Opioid
use or
Heroin
dependence (until off
Opioid
s for at least 7-10 days)
Risk of severe withdrawal
Opioid
s needed for pain control
Hepatitis or
Liver
failure
Adverse effects
Hepatotoxicity (dose dependent)
Nausea
(10%)
Headache
Anxiety
Sedation
Mechanism
Reduces
Alcohol
craving
Decreases impulsive use of
Opioid
s
Efficacy
Initial studies showed relapse reduction by 50%
Recent large DBPCT showed no benefit with Naltrexone
Relapse rate: 38% at 13 weeks (44% with
Placebo
)
Compliance rate low: 42-44% in all groups
Krystal (2001) N Engl J Med 345:1734-9 [PubMed]
Adverse effects
Nausea
or
Vomiting
Abominal pain or cramping
Headache
Dizziness
Fatigue
Insomnia
Anxiety
Arthralgia
s or myalgias
Risk of lethal
Opioid Overdose
on relapse
Decreased
Opioid
tolerance after use
No toxicity if drinking with Naltrexone
Not indicated to make them social drinkers
Alcohol
ics tend to get less drunk on Naltrexone
Very broad safety profile with minimal adverse effects
However,
Opioid
use is a contraindication
Hepatotoxicity, however is a risk
Croop (1997) Arch Gen Psych 54:1130-5 [PubMed]
Monitoring
Obtain serum liver transaminases periodically
Baseline
Repeat at 3 months, then every 3-6 months
Dosage
Frequency options
Daily
Naltrexone 50 mg orally daily
Alternate days
Naltrexone 100 mg orally on Monday, Wednesday and Friday
Monthly (expensive - as much as $1300 per month in 2017)
Vivitrol 380 mg injection every 4 weeks (appears less effective than oral dosing)
Duration
May need to be used for 1 year or longer
Safety
Pregnancy Category C
Lactation
: Unknown
References
(2018) Presc Lett 25(1):5
Hartmann (1997) Am Fam Physician 55(5):1877-9 [PubMed]
Williams (2005) Am Fam Physician 72(9):1775-80 [PubMed]
Winslow (2016) Am Fam Physician 93(6): 457-65 [PubMed]
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