Does taking naltrexone after Sublocade (buprenorphine) eliminate it from the system for good?

Naltrexone After Sublocade: Effects on Buprenorphine Elimination

No, taking naltrexone after Sublocade (buprenorphine) will not eliminate it from the system for good, but it will block its effects while potentially precipitating withdrawal symptoms. 1

Pharmacological Interactions Between Naltrexone and Sublocade

• Naltrexone is a competitive opioid receptor antagonist that blocks the effects of opioids, including buprenorphine (Sublocade) 1
• Sublocade (extended-release buprenorphine) has a prolonged presence in the body, with detectable levels for months after administration 2
• Taking naltrexone while Sublocade is still in your system doesn't eliminate the buprenorphine molecules, but rather competes with them at opioid receptor sites 1

Potential Consequences of Taking Naltrexone After Sublocade

• Precipitated withdrawal: Naltrexone can displace buprenorphine from opioid receptors, potentially causing acute withdrawal symptoms 2
• Blocking effects: Naltrexone will block the therapeutic effects of buprenorphine while both medications are present in the system 1
• Duration of antagonist effects: Naltrexone's effects persist for 2-3 days after discontinuation due to its active metabolite (6-β-naltrexol) 1
• Extended-release naltrexone formulations have even longer durations of action (24-30 days) 2

Clinical Considerations

• Patients transitioning between these medications require careful management to avoid severe withdrawal 3, 4
• The Society for Perioperative Assessment and Quality Improvement recommends:
  • Oral naltrexone should be held 2-3 days before procedures requiring opioids 2
  • Extended-release naltrexone should be held 24-30 days before procedures requiring opioids 2
• Some clinical protocols use very low dose naltrexone with tapering buprenorphine doses to manage transitions, but this requires medical supervision 3, 4

Important Cautions

• Self-administering naltrexone while on Sublocade can lead to severe withdrawal symptoms 2, 1
• Medical supervision is essential when transitioning between these medications 5, 3, 4
• Patients may require higher doses of opioid analgesics if they need pain management while transitioning due to receptor upregulation 1
• Any transition between these medications should be managed by healthcare providers experienced in addiction medicine 6, 7