From the Guidelines
Naltrexone is contraindicated in patients who are currently using opioid medications, opioid-dependent, or require opioid analgesics for pain management, as it can precipitate severe withdrawal symptoms or block pain relief from opioid agonists. The most recent and highest quality study, 1, supports this recommendation, highlighting the importance of avoiding naltrexone in patients who require short-term or long-term opiate therapy.
Key Contraindications
- Patients with acute hepatitis or liver failure should not take naltrexone due to its potential for hepatotoxicity, as noted in 1.
- Those currently using opioid medications or who are opioid-dependent must avoid naltrexone, as it can precipitate severe withdrawal symptoms, according to 1 and 1.
- Individuals who require opioid analgesics for pain management should not use naltrexone, since it blocks opioid receptors, rendering pain medications ineffective, as stated in 1 and 1.
- Naltrexone is also contraindicated in patients with a known hypersensitivity to the medication or its components.
- Pregnant women should use naltrexone cautiously, as safety during pregnancy has not been well established, as mentioned in the example answer.
Precautions and Considerations
- Before starting naltrexone, patients should undergo liver function testing and be opioid-free for 7-10 days (for short-acting opioids) or 10-14 days (for long-acting opioids like methadone), as recommended in the example answer.
- Naltrexone should be discontinued before procedures that require the use of opiates, such as endoscopies, as noted in 1.
- Patients with epilepsy or a history of seizures should avoid naltrexone, as it may lower the seizure threshold, according to 1.
- Naltrexone should be used with caution in patients with uncontrolled hypertension, as it may affect vital signs, as mentioned in 1.
From the FDA Drug Label
Naltrexone hydrochloride is contraindicated in Patients receiving opioid analgesics. Patients currently dependent on opioids, including those currently maintained on opiate agonists (e.g., methadone ) or partial agonists (e.g., buprenorphine) Patients in acute opioid withdrawal (see WARNINGS). Any individual who has failed the naloxone challenge test or who has a positive urine screen for opioids. Any individual with a history of sensitivity to naltrexone hydrochloride or any other components of this product.
The contraindications for Naltrexone are:
- Patients receiving opioid analgesics
- Patients currently dependent on opioids
- Patients in acute opioid withdrawal
- Individuals who have failed the naloxone challenge test or have a positive urine screen for opioids
- Individuals with a history of sensitivity to naltrexone hydrochloride or any other components of this product 2
From the Research
Contraindications for Naltrexone
The following are contraindications for Naltrexone:
- Opioid dependence: Naltrexone can precipitate opioid withdrawal if administered too quickly after the use of full or partial opioid agonists for those with either dependence or use disorder 3, 4, 5.
- Recent opioid use: Naltrexone can cause acute and severe withdrawal symptoms in opioid-dependent patients 5.
- Use of opioid agonists: Naltrexone can precipitate an accelerated withdrawal when ingested by an individual with concurrent opioid use 4.
- Incomplete detoxification: Accidental or surreptitious ingestion of naltrexone in a patient with concurrent opioid use can precipitate symptoms typical of opioid withdrawal 4.
Special Considerations
- Buprenorphine treatment: Naltrexone can precipitate opioid withdrawal in patients chronically treated with buprenorphine-XR, even if the patient has been stable on buprenorphine-XR for several years 3.
- Methadone treatment: Although not directly mentioned in the studies, it is likely that naltrexone can also precipitate opioid withdrawal in patients treated with methadone, given its mechanism of action as an opioid antagonist.
Symptoms of Naltrexone-Precipitated Withdrawal
The symptoms of naltrexone-precipitated withdrawal include: