What are the important counseling points for naltrexone (opioid receptor antagonist)?

From the Guidelines

When counseling patients about naltrexone, it is crucial to emphasize that they must be completely opioid-free for at least 7-10 days before starting naltrexone to avoid precipitating severe withdrawal symptoms, as supported by the most recent and highest quality study 1.

Important Counseling Points for Naltrexone

The following points should be discussed with patients:

• Patients should understand that naltrexone blocks the effects of opioids, making them ineffective for pain relief, and attempting to overcome this blockade by taking high doses of opioids could lead to overdose or death 1.
• Common side effects include nausea, headache, dizziness, anxiety, fatigue, and insomnia, which typically improve over time.
• Liver function should be monitored as naltrexone can cause hepatotoxicity, particularly at higher doses 1.
• Patients should carry medical identification indicating they are taking naltrexone, as this affects emergency pain management options.
• For the injectable form (Vivitrol), patients should be informed it lasts approximately 28 days and injection site reactions may occur.
• Naltrexone does not cause physical dependence or withdrawal when stopped, but patients should be advised against abruptly discontinuing treatment without medical supervision.
• The medication works by competitively binding to opioid receptors without activating them, thereby blocking the euphoric and pain-relieving effects of opioids while reducing cravings.

Additional Considerations

• Patients should be advised to avoid alcohol and alcohol-containing products while on therapy, as supported by 1.
• It is essential to consider the patient's medical history, current medications, and potential interactions with naltrexone, as outlined in 1.
• Patients should be informed about the potential risks and benefits of naltrexone, including the risk of precipitating withdrawal symptoms if they are not opioid-free before starting treatment.

From the FDA Drug Label

You should carry identification to alert medical personnel to the fact that you are taking naltrexone hydrochloride. Advise patients that if they previously used opioids, they may be more sensitive to lower doses of opioids and at risk of accidental overdose should they use opioids after naltrexone hydrochloride treatment is discontinued or temporarily interrupted Patients should be off all opioids, including opioid-containing medicines, for a minimum of 7 to 10 days before starting naltrexone hydrochloride in order to avoid precipitation of opioid withdrawal Advise patients that they should not take naltrexone hydrochloride if they have any symptoms of opioid withdrawal. Patients on naltrexone hydrochloride may not experience the expected effects from opioid-containing analgesic, antidiarrheal, or antitussive medications.

The important counseling points for naltrexone are:

• Carry identification to alert medical personnel that you are taking naltrexone hydrochloride 2
• Risk of overdose if opioids are used after naltrexone hydrochloride treatment is discontinued or temporarily interrupted 2
• Opioid-free interval of at least 7-10 days before starting naltrexone hydrochloride to avoid precipitation of opioid withdrawal 2
• Avoid taking naltrexone if you have any symptoms of opioid withdrawal 2
• No effect from opioid-containing medications while taking naltrexone hydrochloride 2
• Risk of liver injury and need to notify physician if symptoms occur 2
• Risk of depression and need to notify physician if symptoms occur 2
• Dizziness and need to avoid driving or operating heavy machinery until effects are known 2

From the Research

Important Counseling Points for Naltrexone

The following are key points to consider when counseling patients about naltrexone:

• Avoidance of certain substances: Patients should avoid benzodiazepines and alcohol while on naltrexone therapy, as these substances can interact with naltrexone and increase the risk of adverse effects 3, 4.
• Risk of withdrawal: Patients should not stop taking naltrexone without talking to their doctor, as this can lead to withdrawal symptoms 4, 5.
• Initiation of therapy: Naltrexone should not be initiated for at least 7-10 days after opioid use, and patients should be opioid-free before starting therapy 6, 7.
• Emergency procedures: Patients should always carry an emergency card with them to alert providers that they are on naltrexone therapy, and preferred pain management is with NSAIDs and/or acetaminophen 6.
• Monitoring and follow-up: Patients should be closely monitored for signs of withdrawal, and follow-up appointments should be scheduled regularly to assess treatment efficacy and address any concerns 5.

Special Considerations

• Compliance with therapy: Patients should be encouraged to comply with naltrexone therapy, as non-compliance can lead to relapse and decreased treatment efficacy 3, 5.
• Support systems: Patients should have strong family and social support systems in place to help them stay motivated and compliant with therapy 7.
• Dose and administration: The usual dosage of naltrexone hydrochloride is 50 mg orally once daily or 350 mg orally per week in three divided doses, and patients should be detoxified and opiate-free for two to five days before initiation of naltrexone therapy 7.